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Adolescent Mental Health: Population-based Disaster Prevention

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Adolescents are rarely the 'puppy of choice at the pound' ... to finance interventions and outreach who will adopt the adolescent population ... – PowerPoint PPT presentation

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Title: Adolescent Mental Health: Population-based Disaster Prevention


1
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

2
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

3
Adolescent Mental Health
  • Using Key Data Indicators to Motivate Strategic
    Action
  • Why We Need a Bracelet

4
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

5
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.

6
Adolescent Mental Health
  • Identifying Conceptual and Practical Barriers to
    Addressing Need
  • What to Consider in Developing our Bracelet

7
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

8
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

9
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)

10
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

11
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

12
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

13
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

14
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

15
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

16
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

17
Adolescent Mental Health
  • Developing Public Health Strategies that
    Cultivate Adolescent Mental Health
  • Designing Our Bracelet

18
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

19
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

20
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

21
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

22
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

23
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

24
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

25
Adolescent Mental Health
  • What will our bracelet be?

26
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

27
I survived. - Daniel

28
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).

29
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.
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