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November 2005
Prevalence and Costs of Mental Illness
It is estimated that 1 out of 10 children in the US The presence of mental illnesses is often linked have a mental illness severe enough to cause to social, academic, and legal problems for many significant functional impairment; the incidence is believed to increase to 2 out of 10 when Commission, approximately 50% of adolescents considering mental disorders that cause at least in the judicial system have been diagnosed with some impairment. However, fewer than one in a mental illness, and 20% are under the care of five of these children receive needed treatment psychotropic medication for their illness (Mental (Greenberg et. al. 2001). Like many other Health Association in Texas 2005). Limited diseases, early diagnosis and intervention is access to mental health services causes further often crucial to minimize further complications burden on the state and families. In 2002, there throughout childhood and into adulthood. were 244 children whose parents relinquished custody of them to the state, 82% of these In 2002, there were nearly 420,000 children in relinquishments were a last resort measure by the parents because they had no other way to significant enough to impair their social, home, Association in Texas 2005). It is estimated that Association in Texas 2005). Of these, 151,000 the cost to care for these children as wards of the were eligible to receive mental health services state is $9.7 million as compared to the cost of through the Texas Department of Mental Health providing the mental health care these children and Mental Retardation, but only 26% of those were unable to access, $6.3 million (Mental that were eligible actually received these Health Association in Texas 2005). In 1990 services (Mental Health Association in Texas alone, it was estimated that mental illness cost the United States 74.9 billion dollars (Greenberg children who suffered from mental illness et. al. 2001). Another implication of increased significant enough to impair their social, home, mental illness and a lack of proper treatment are and academic functioning, but only 20% of increased rates of suicide among youth. In those who needed services and were eligible and Texas, there are 1 ½ times more suicides than received care, a rate lower than Dallas, El Paso, homicides, and of the suicides carried out, 90% Harris, and Travis Counties (Mental Health are related to under-treated mental illness. In Bexar County in 2001 alone, 27 young people committed suicide (Mental Health Association Most disorders are diagnosed after the child’s sixth birthday but signs of mental health problems may be evident in some children as Common Diagnoses in Children
early as infancy. In a national study of child One of the most common types of mental illness mental health service recipients, 9% were under is disruptive behavior disorder, such as Attention 6 years of age, 40% were between the ages of 6 Deficit Hyperactivity Disorder, with 31% of all and 12, and 51% were between 13 and 17 (The youth receiving mental health services being Child Mental Health Research Brief November 2005
Foundation 2005). Between 3 and 5 percent of fact, the only antidepressants currently allowed all youth ages 9-17 are believed to suffer from for children under age 18 are Anafranil, Luvox, ADHD; this means that in a typical classroom of 25 to 30 children, it is likely that one or more of importantly, the hugely popular and widely those children will be suffering from ADHD subscribed SSRIs, Paxil and Prozac are now not (National Institute of Mental Health 2005). (National Institute of Mental Health 2005c). characterized by an inability to stay focused on The third most common form of mental illness activity, constant fidgeting, excessive talking, among youth is adjustment disorder, affecting and trouble paying attention and following instructions (National Institute of Neurological services in the U.S. (The Annie E. Casey Disorders and Stroke 2003). Treatment for Foundation 2005). Adjustment behavior is ADHD typically consists of behavioral therapy characterized as a response to an identifiable to control impulsive behavior and stimulants, psychosocial stressor and includes symptoms such as anxiety, misconduct, and a depressed Another of the more common forms of mental illness present in children and adolescents are Contributing Factors
mood disorders, which include depressive Both biological factors and personal experiences disorders and bipolar disorders. Depressive impact the emergence of mental illness among disorders affect approximately 5% of children, children. Some of the more common risk factors and the number of children suffering from for mental health problems among children are: bipolar disorder is unknown (National Institute of Mental Health 2005b, Goldman 2005). Of the children receiving mental health services in the United States, 21% have a mood disorder (The Annie. E. Casey Foundation 2005). Symptoms for these disorders include intense sadness and despair, hopelessness, loss of pleasure in activities that had once been enjoyable, and Foundation 2005). Depression is also highly linked to genetic factors. Between 20% and 50% of depressed children and adolescents have a family history of depression, and children of depressed parents are over three times as likely as children of nondepressed parents to be (U.S. Surgeon General 1999, Greenberg et. al. diagnosed with a depressive disorder (Children and Mental Health). Typical treatment for mood disorders includes medication, such as selective Early Detection and Intervention
serotonin reuptake inhibitors, mood stabilizers, The following quote epitomizes the importance antidepressants, and psychotherapy for such of prevention for the field of mental health. disorders. However, the use of antidepressants “Cancer treatment is more effective when the has come under fire due to a possible increase in disease is caught early. Ditto for heart disease suicidal behavioral seen in children using these that’s treated before a stroke or a heart attack. drugs. The US Food and Drug Administration But, in mental health, most patients suffer for and the National Institute of Mental Health have months or years before doctors intervene” (Johnson 2005). Over the past decade or so, antidepressants used for depression in children prevention of mental illness in children has (National Institute of Mental Health 2005). In slowly become a priority. This is evidenced by November 2005 Child Mental Health Research Brief
a paradigm shift of federal agencies in their many mental disorders. PMHP specifically policy, practice, and research (Greenberg et. al. addresses emotional and behavioral problems 2001). To reduce the large number of America’s such as aggression and withdrawal that hinder youth with mental illness problems, therapeutic successful learning. Though screening, PMHP interventions need to begin earlier, and ideally, selects students with adjustment problems, who these interventions should be provided to at risk then receive services through an individualized program. This program includes school mental symptomology. As the system stands currently, health professionals, the child’s family, and the many children do not become eligible for homeroom teacher. Students are seen in groups clinical care until it is mandated by a juvenile or individually once or twice a week for short 30 to 60 minute sessions. These training sessions focus on improving both learning and social There are three categories of prevention. skills and have yielded promising results. Universal preventative interventions include the Significant improvements in grades and test general public or a large population group. scores, a reduction in acting out, shyness, and Selective interventions target individuals or anxious behaviors, and increased frustration subgroups whose risk of developing a mental disorder is higher than average; and indicated Report of the Surgeon General, Primary Mental interventions target people who have biological markers and sub-threshold symptoms for mental illness but do not yet meet diagnostic criteria. Initiatives such as these are on the right track to The following are a few specific interventions preventing mental illness. It is imperative that that have been tested for their effectiveness prevention programs and early interventions address universal, selective, and indicated levels of influence to be effective. Making resources The Coping with Stress Program attempted to available at all levels such as communities, prevent depression in a sample of high school schools, families, and individuals is critical to students. After the 15 session intervention, their analyses through 12 months post intervention intervention. Many experts see children more indicated that there were significantly fewer much more resilient with regard to mental health However, resiliency requires early and sufficient compared to the controls. Another promising intervention to reduce the long-term effects of an finding is a study that used two popular suicide prevention programs, a C-CARE group, a C- CARE plus CAST group, and a “care as usual” Resources for Treatment
control group to test these intervention’s affects Resources for the treatment of mental illness significant decreases in suicide risk behaviors Services, Medicaid, and CHIP. Over 57% of the children treated for mental health problems in interventions reported lower levels of depression U.S. in 1997 were poor, with 42% having their and higher self-esteem when compared to the care paid for by Medicaid, 31% through private control group. Additionally, subjects that insurance, and 10% through some other public received the CAST intervention along with the insurance (The Annie E. Casey Foundation 2005). The Texas Department State Health improvements in problem solving, self control, Services provides services for children and and perceived family support (Greenberg et. al. adolescents ages 3 through 17 years with a 2001). Another promising program, the Primary diagnosis of mental illness, but only if they Mental Health Project, has a 42 year history of exhibit serious emotional, behavioral, or mental disorders (Texas Department of State Health children’s adjustment problems; the catalyst to Services 2005). They do not provide for the Child Mental Health Research Brief November 2005
treatment of less severe mental disorders and have recently seen some funding cuts as well. Medicaid continues to provide for mental health services, but because it is a program for the Children Defense Fund. (2003). Campaign to indigent, many who do not qualify still go untreated. The Texas Children’s Health Insurance Program was intended to pick up those that fell through the cracks of the state mental health system, especially after the cuts to program. However, during the 78th Legislative session, all but the most basic mental health care were slashed. However, through a grant from the U.S. Department of Health and Human Services, mental health services have been partially • Substance abuse detoxification services • 30 outpatient visits for substance abuse Globe. Doctors See Need for Prevention in Mental Illness. [Online]. Available: Other community resources that are available for mental health treatment at a reduced or sliding fee include: Center for Healthcare Services, Alamo Children’s Advocacy Center, Benitia Mental Health: A Report of the U.S. Surgeon Neighborly Services, and the Mental Health Association. Given the complexity of the mental health needs of children and their families it is Mental Health Association in Texas. (2005). important to emphasize that there is no single solution to address the mental health needs of prevention and intervention efforts that children’s mental health problems can be better prevented and addressed. It is important for National Institute of Mental Health. (2005). communities to offer an array of services and Attention Deficit Hyperactivity Disorder. improved outcomes for children and families. References:
National Institute of Mental Health. (2005b). The Annie E. Casey Foundation (2005). Update: Health., Vol. 1, No. 1-2, Vol. 2, No. 1. November 2005 Child Mental Health Research Brief
National Institute of Mental Health. (2005c). U.S. Food and Drug Administration (2004). Psychopharmacological Drugs and Pediatric Advisory Committees. [Online]. Available: U.S. Surgeon General. (1999). Mental Health: A Texas Department of State Health Services. report of the Surgeon General. {online].


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