In recent years I’ve noticed I become sad in September. It’s not because September signals the end of summer, the further recession of my wayward youth into the past or some precursor of seasonal depression. Rather, it’s because September is when our youth return to school, and, being a psychiatrist, I become acutely aware of the challenges they will face growing up in today’s world, and dismayed at our inaction in helping them.
[See: 10 of the Biggest Health Threats Facing Your Kids This School Year.]
Mental health professionals have long known that youth is the sweet spot for mental illness. This is because most mental disorders manifest their first signs early in life, meaning from childhood to young adulthood. One in five people experience a mental health condition before age 25, and 75 percent of all lifetime mental health conditions begin in the first quarter century of life. Here’s why:
— Your genetics and early environment greatly influence your chances of developing mental illness.
— The largest and most rapid maturational changes in the brain occur during childhood and adolescence, making it more vulnerable to trauma, stresses and toxins, and creating more opportunities for things to go wrong during these periods.
— The environmental pressures that are associated with growing up — social and academic pressures, the Internet, social media and recreational drugs, to name a few — have become greater in the modern age.
Growing up has never been easy, but it seems more hazardous now. Statistics bear this out. A 2013 survey by the American College Counseling Association found that 25 percent of students arrive on campus already taking psychotropic medication. It also found that nearly all student mental health service directors think there are more students seeking help for serious mental problems, more on-campus physical and sexual assaults, and more frequent high-risk and self-harmful behaviors.
Rates of mental disorders — including depression, addiction, suicide, psychological trauma, eating disorders, attentional disorders and learning disabilities — are rising in their respective age groups. This may be due in part to the idea that millennials are more sensitive and less resilient than past generations; or alternatively, that the complexities of growing up in the modern age are more challenging. While both reasons may be true to an extent, our society also needs to be more aware and better able to treat mental disturbances than in the past.
But we are not. In the course of my career, I have seen many young people whose education and lives were derailed by mental illness that was not accurately diagnosed and adequately treated in a timely fashion. In the worst cases, this oversight can lead to irreparable damage in their lives, lifelong disability and even suicide. In rare instances, this lack of action can also result in violent assaults on the victim’s family members or random acts of violence toward total strangers.
How and Where We Can Intervene
When asked why he robbed banks, the notorious Willie Sutton famously responded, “Because that’s where the money is.” Similarly, if we want to interdict mental disorders before they harm young people, we should focus on settings that make sense — namely, in pediatricians’ offices and schools.
However, we have failed to take advantage of this opportunity. While pediatricians ruefully acknowledge that 40 percent of their practices involve dealing with mental and behavioral problems, they receive a woefully inadequate amount of child psychiatry training. Even when pediatricians take the initiative to acquire specialized expertise in child mental health, they do not have the time to provide adequate care. Nor can they readily refer patients to a specialist, since there is a serious shortage of child psychiatrists. While it would be ideal to embed or co-locate mental health professionals in primary care settings (aka “collaborative care”), this model is only infrequently implemented.
[See: How to Find the Best Mental Health Professional for You.]
We also need major improvements in schools. Most educational institutions neither want the responsibility nor are prepared to meet the mental health needs of their students. They also lack adequate — much less, optimal — resources to provide good mental health care. Primary and secondary schools have limited health care personnel on site and usually rely on referral networks of clinicians that vary in quality and scope. These schools have neither the budgets nor the incentives to provide better mental health services.
At universities, where students are residing for four years, and not just attending for several hours a day, the most common form of treatment provided by student mental health services is crisis counseling and psychotherapy. University administrators, meanwhile, only began accepting the responsibility of developing comprehensive and state-of-the-art mental health services for students when increased behavioral incidents including suicides, sexual assaults and trauma, binge drinking and drug use forced them to. Their delay and reluctance is partly due to cost, but also to liability.
However, to provide the right types of evaluation and treatment, universities must employ and provide students access to an array of treatments administered by trained personnel, including psychiatrists, psychologists, social workers and substance abuse counselors. Institutional officials, along with students and parents, also need to make complex decisions about when students can receive treatment at school, and when they need to take a leave of absence to seek outside care. In the case of the latter, when recovered, the affected student needs to be seamlessly transitioned back to the school’s student health service upon resuming their education.
There are other more proactive and comprehensive strategies in mental health care that could be adopted to achieve the desired goals of improving overall mental health of this population, and that could reduce the consequences of mental illness. These include:
— Screening students for cognitive impairments beginning in primary school and referring them for diagnostic testing and treatment.
— Providing on-site evaluations in schools of any students exhibiting behavioral problems or showing signs of untoward mental function, and referring them to qualified outside clinicians when necessary.
— Educating students and families about mental illness and substance abuse through in-person, web-based or print materials.
— Implementing a system for monitoring, following up with and continuously assessing the outcomes of students who received treatments while they were in school, on vacations or leaves of absence.
[See: 11 Simple, Proven Ways to Optimize Your Mental Health.]
To attack mental illness in its sweet spot, we should adopt a public health approach to providing mental health services through our primary care and educational systems. The reality is that this health problem is “low-hanging fruit” and does not require rocket science to fix. But it does require the social and political will, which I hope we will muster before next September.
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Why and How to Improve Mental Health Services for Youth originally appeared on usnews.com
