Addressing the Needs of America's Mentally Ill Youth

Our poor handling of mentally ill youth as they enter adulthood is a sad comment on our society. People with mental disorders are not a voting block or disenfranchised group who hold special appeal to our politicians.
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As a clinical child and adolescent psychiatrist, the recent tragedy in Newtown, Conn. provides me with yet another somber example of America's inability to address the proper care and treatment of our young people living with mental illness. It is easier to ignore this population and wring our hands when tragedy strikes than it is to confront their needs by engaging in open and frank discussions of how best to serve their needs.

From what has been reported in the media, it would be inappropriate and unfair for anyone, especially a mental health professional, to speculate on Adam Lanza's mental health and diagnosis. But -- there is no question that his actions were those of an ill individual. There are reports in the media of his chronic social isolation, and reportedly his own mother was attempting to get conservatorship with the possible goal of committing him to psychiatric care. Although discussion of the role of mental illness in the tragedy in Newtown, Conn. is conjecture at best, for many parents, fears for and about their mentally ill youth were heightened. This is the issue I want to address in this article.

Most parents that struggle with a mentally ill grownup child know that once their offspring becomes an adult (i.e., 18 years of age or older) parental rights become legally limited, and often almost nonexistent. Our government, legal system, and social support mechanisms offer minimal and insufficient support for our children with mental illness as they age.

Our poor handling of mentally ill youth as they enter adulthood is a sad comment on our society. People with mental disorders are not a voting block or disenfranchised group who hold special appeal to our politicians. We hear people, especially during election years, talk about children being our future, but the reality is that our young people -- especially those living with a mental disorder -- lack monetary and therefore political power. When it's time for budget cuts, their needs are quickly ignored or forgotten in exchange for what are deemed more "crucial" (i.e., politically important) issues.

We have watched silently as the criminal justice system has become the refuge of our society's most fragile and ill members, no matter their age -- and where the psychological/psychiatric care they desperately need is often neglected or is substandard. It is not the job exclusively of the parents, educators, mental health practitioners of these young people, or others involved with children's welfare to work for reform. It is time for all of us to step up to the plate and be actively involved. It is our mandate as a free society to recognize our responsibility to take better care of our future generations if we want America to continue to exist as a country proud of its morals and ethics -- a place where the American dream still holds promise for all of our children.

Right now over 4 million children and adolescents suffer from a serious mental disorder that significantly interferes with their ability to function: at home, at school and with peers.[1] Yet there is evidence that fewer than one half of children with a diagnosable mental disorder -- i.e., kids who can use help -- actually receive mental health services in a given year.[2]

Our focus needs to be on prevention and early intervention when addressing mental health, just as we now acknowledge their importance for obesity, hypertension, diabetes and other medical illnesses. Evidence indicates that approximately half of all lifetime cases of mental disorders begin by age 14.[3] A sobering statistic is that over 50 percent of students with a mental disorder age 14 or older, drop out of high school. This is the highest dropout rate of any disability group studied.[4] The consequences of this action can be lifelong.

In addition to the profound social/emotional toll that these illnesses take, they present tremendous economic costs to both the individual and society. In 2006, the Agency for Healthcare Research and Quality reported that the cost of mental health care in the United States was $57.5 billion, a figure that was equivalent to the cost of cancer care. As noted by Thomas Insel, Director of the National Institute of Mental Health (NIMH), "Unlike cancer, much of the economic burden of mental illness is not the cost of care, but the loss of income due to unemployment, expenses for social supports, and a range of indirect costs due to a chronic disability that begins early in life." Clearly, the economic toll that the present approach to mental illness propagates is staggering.

Given all that we know scientifically and financially, how can we as a nation continue to ignore the plight of our mentally ill brethren? It's time for people to join together and start helping strengthen our future and our most fragile.


1 U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville,MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.

2 U.S. Public Health Service, Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda. Washington, DC: Department of Health and Human Services, 2000.

3 Wang, P., Berglund, P., et al. Failure land delay in initial treatment contact after first onset of mental disorders in the National Co-Morbidity Survey Replication (NCS-R). General Psychiatry, 62, June 2005, 603-613.

4 U.S. Department of Education. Twenty-third annual report to Congress on the implementation of the Individuals with Disabilities Act. Washington, D.C., 2006.

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