Adolescent Mental Health: Population-based Disaster Prevention

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Adolescent Mental Health Population-based
Disaster Prevention

• Gwendolyn J. Adam, Ph.D., L.C.S.W.
• Assistant Professor - Department of Pediatrics
• Section of Adolescent Medicine and Sports
  Medicine
• MCHB-funded Leadership Education in Adolescent
  Health (LEAH) Program
• Baylor College of Medicine

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Goals Objectives

• Goal Understand critical issues in adolescent
  mental health as public health opportunities for
  population-based disaster prevention.
• Objectives
• Utilize key data indicators of adolescent mental
  health to motivate strategic action
• Identify conceptual and practical barriers to
  addressing adolescent mental health needs
• Develop strategies for improving public health
  cultivation of adolescent mental health

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Adolescent Mental Health

• Using Key Data Indicators to Motivate Strategic
  Action
• Why We Need a Bracelet

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Key Data Indicators Demonstrate that Mental
Health Issues

• are prevalent among U.S. adolescents
• 1 in 10 children / adolescents suffers from
  mental illness severe enough to result in
  significant functional impairment - It is
  estimated that 20 of children / adolescents have
  a diagnosable mental disorder
• (in 2004) 3.5 million youth (14) ages 12-17 have
  experienced at least one major depressive episode
  in their lifetime
• lead to lethal thoughts and acts
• suicide - 3rd leading cause of death for
  adolescents
• 900,000 youths (3.6) made a plan to kill
  themselves during worst or most recent Major
  Depressive Episode
• 712,000 youths (2.9) tried to kill themselves
  during such an episode
• impact other behavioral health risks e.g. drug
  and alcohol use
• have family system implications - parent mental
  health affects adolescent health risk behavior
• are not adequately addressed for adolescents -
  less than half of depressed adolescents receive
  treatment when they need it

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Key Data Indicators Demonstrate that Mental
Health Issues

• impact other behavioral health risks e.g. drug
  and alcohol use
• have family system implications - parent mental
  health affects adolescent health risk behavior
• are not adequately addressed for adolescents -
  less than half of depressed adolescents receive
  treatment when they need it
• escalated for adolescents - between 1960 and 2000
  the suicide rate among adolescents increased 128
  as compared to an increase of 2 in the general
  population.

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Adolescent Mental Health

• Identifying Conceptual and Practical Barriers to
  Addressing Need
• What to Consider in Developing our Bracelet

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Conceptual Barriers Understanding Adolescents

• Myths regarding adolescents undermine parental
  and provider recognition of distress
• Youth want to be alone
• Youth dont talk to adults
• Youth behavior is consistent if depressed will
  look depressed always / or at all
• Sulking, minimal eye contact, no communication,
  sleep all day, outrageous moods, angry, violent,
  substance use, not eating - are normal
• When in need youth just want adults to listen

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Conceptual Barriers Understanding Adolescents

• Stereotypes of adolescents keep others away and
  reinforce the myths
• Adolescents are rarely the puppy of choice at
  the pound
• Stereotypes tend to influence adult approach to
  interaction little communication, passive
  approach to parenting and intervention
  reinforce the expected disconnect between youth
  and adults

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Conceptual Barriers Understanding Adolescents

• Risk behaviors are meaningful and may or may not
  be rebellious / may be palliative
• Youth recognize distress in each other and go to
  one another for help / give feedback
• Youth friends are often alienated by adults when
  mental health issues emerge
• Manifestation of mental health issues in
  adolescents differs from adults (e.g. sadness
  versus irritability, overcompensation)

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Conceptual Barriers Stigma

• Parents are fearful of blame in seeking help I
  love my child.
• Concern regarding the records and the labels
• Parents sometimes choose risk of adolescents
  death over risk to their future
• Fear of failure or reality as a parent this
  just isnt my kid to go ahead and kill
  yourself
• Reliance upon parents to facilitate mental health
  care access despite above concerns
• Youth stigmatize need for counselors equate
  with need for attention or to get out of school

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Conceptual Barriers Public Health Expectations

• There is no mental health equivalent to the
  federal governments commitment to childhood
  immunization. David Satcher, M.D., Ph.D.
• Psychosocial Immunizations
• imagine required mental health screening for
  school
• barriers reflect stigma around mental health
  issues and problems with access to care
• outcomes of preventable diseases may be less
  lethal than mental health crises
• parental expectation in responsibility differs
  from shots
• critical impact on educational process yet not
  standardized

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Conceptual Barriers Public Health Expectations

• Mental illnesses are internal terrorists
• Disaster prevention versus disaster preparedness
  versus crisis intervention
• Public awareness and motivation regarding youth
  mental illness are generally limited to headlines
• Columbine High School Massacre (1999) 12
  homicides / 2 suicides / 24 injured versus 4,243
  completed suicides in 2001 for similar age group
• Opportunity to focus on impact of bullying,
  isolation, depression, violent media, social
  relationships, anger management, etc.
• Response gun control / metal detectors versus
  mental health screening and responses

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Conceptual Barriers Public Health Expectations

• Adolescent failure to thrive concept missing
• Quality of life I survived. Daniel
• Symptoms are not the only thing to consider
• emotional and social readiness for school
• impact of staying sad or anxious for several
  years during key development period
• impact on learning and social development
• Most of the treatments / services adolescents
  typically receive have not been evaluated to
  determine efficacy across developmental periods

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Conceptual Barriers Public Health Expectations

• Challenges exist in identifying mechanisms by
  which ethnicity, race and culture account for
  disparities in behavioral and emotional problems
  and service delivery
• Lack of early detection by providers and parents
• Untrained and / or culturally insensitive
  providers
• Lack of parent / provider knowledge of
  developmentally appropriate AND efficacious
  treatment
• Insurance status
• Settings where mental health care is delivered

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Conceptual Barriers Public Health Expectations

• National measurement focus on teen suicide and
  teen pregnancy negative orientation
• Asset-based measurement screen for strengths
  and measure impact over time
• Cultivating mental health versus documenting
  mental illness role of public health in
  shifting focus

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Conceptual Barriers Public Health Expectations

• Estimating economic burden of mental health
  concerns in adolescents is understudied and
  difficult to assess
• multiple systems providing services
• serious events severe criminal acts / suicide
• loss in later educational and work productivity,
  parental productivity
• positive impact of prevention programs to
  decrease role of current treatment and increase
  productivity later
• must involve multiple stakeholders

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Adolescent Mental Health

• Developing Public Health Strategies that
  Cultivate Adolescent Mental Health
• Designing Our Bracelet

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Public Health Strategies Using What Evidence
Demonstrates

• Psychosocial intervention enhances
  pharmacological treatment
• Multi-systemic therapy promising addresses child
  and child context
• Some forms of institutional care do not lead to
  lasting change when adolescent is returned home
• Services to delinquent youth like boot camps and
  residential programs generally ineffective
• Some peer-group based interventions actually
  increase behavior problems

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Public Health Strategies Need for
Interdisciplinary Approaches

• Must eliminate discipline insularity
• Effective treatment practices must be shared
  across disciplines
• Primary care and mental health disciplines must
  jointly develop and utilize screening and
  prevention tools
• Research should include mental health and health
  disciplines

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Public Health StrategiesMaking Science
Accessible

• Development of research should begin with the
  context and placement of the intervention as a
  focus
• Must involve youth and family, community and
  treatment stakeholders, in partnership with
  researchers from the beginning
• Factors influencing ultimate dissemination must
  be considered during development

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Public Health StrategiesImpact is Everything

• Messages must be clear and organized to overcome
  adolescent-specific issues
• difficult to imagine the icon of adolescent
  mental health
• many adolescent mental health difficulties by
  nature include resistance (depression lack of
  energy or hope, substance addiction, eating
  disorders)
• risks are behavioral involve blame
• developmental process may require that providers
  be vulnerable to be effective with youth

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Public Health StrategiesImpact is Everything

• Message must be compelling
• Enlist creative partnerships to finance
  interventions and outreach who will adopt the
  adolescent population
• Time-limited adolescence is a statutory
  offense / opportunity
• Now or later approach untreated mental health
  issues in adolescents often become adult problems
  and / or disabilities

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Public Health StrategiesImpact is Everything

• Message must be effective
• Issues are life-threatening disaster prevention
  
• Mental illness has no lobby or does it?
• Enlist public interest, energy and outrage
• Involve youth
• Empower families
• Encourage evaluation to measure impact

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Public Health StrategiesImpact is Everything

• Message must be exponential
• Maximize public health power / minimize public
  health expenditures
• Intentional epidemic / outbreak / wildfire
  public health expertise reversed
• Involve all layers / stakeholders
• Increasingly self-sustaining

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Adolescent Mental Health

• What will our bracelet be?

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Summary

• Discussed critical issues in adolescent mental
  health as public health opportunities for
  population-based disaster prevention
• Encouraged use of adolescent health key data
  indicators to motivate strategic action
• Identified conceptual and practical barriers to
  addressing adolescent mental health needs
• Developed strategies for improving public health
  cultivation of adolescent mental health

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I survived. - Daniel

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References

• Blueprint for Change Research on Child and
  Adolescent Mental Health, Report of the National
  Advisory Mental Health Councils Workgroup on
  Child and Adolescent Mental Health Intervention
  Development and Deployment, Executive Summary and
  Recommendations (2000)
• DASIS Report Adolescents with Co-Occurring
  Psychiatric Disorders 2003
• National Adolescent Health Information 2004 fact
  Sheet on Suicide Adolescents and Young Adults.
  NAHIC (2004).
• National Survey on Drug Use and Health Report
  Depression Among Adolescents. Substance Abuse and
  Mental Health Services Administration (2004).
• National Survey on Drug Use and Health Report
  Mothers Serious Mental Illness and Substance Use
  Among Youths. Substance Abuse and Mental Health
  Services Administration (2004).

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References

• National Survey on Drug Use and Health Report
  Office of Applied Studies. Substance Abuse and
  Mental Health Services Administration
  (2003-2004).
• National Survey on Drug Use and Health Report
  Suicidal Thoughts Among Youths Aged 12 to 17 with
  Major Depressive Episode. Substance Abuse and
  Mental Health Services Administration (2004).
• New DAWN Report Disposition of Emergency
  Department Visits for Drug-Related Suicide
  Attempts by Adolescents, 2004
• Preventing Child and Adolescent Mental Disorders
  Research Roundtable on Economic Burden and Cost
  Effectiveness (2004)
• U.S. Public Health Service, Report of the Surgeon
  Generals Conference on Childrens Mental Health
  A National Action Agenda. Washington, DC
  Department of Health and Human Services, 2000.