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Check Your Head: Examining Youth Mental Health Resources
Welcome to the first feature in WireTap magazine's Mental Health and Youth series. In the coming weeks we'll examine the myriad ways young people cope with mental and psychiatric conditions and explore what needs to change in order to achieve mental healthcare equity.
You probably know what to do if you get sick in school. Stomachache? See the nurse, or go home early and get some rest. But what do you do if you're feeling depressed, anxious or having trouble concentrating in class? What's the plan of action when it's not your body, but your mind that feels ill?
Adults across the education and medical spectrum are interested in answering these questions. Nationally, teen suicide remains the third leading cause of death among young people aged 15 to 24. Untreated learning disabilities or mental health problems are also a contributing factor in high school dropout and delayed graduation rates. Of the nearly 15 million young people diagnosed with a mental disorder, only about one-quarter of them receive the treatment that they need.
Pediatricians, psychologists and educators continue to debate over the best solution. Some argue that schools are the best place to reach out to young people while others suggest that primary care physicians are a better route. What is generally agreed upon is that the dearth of mental health resources for teens is an epidemic that can't be ignored. Youth seeking psychiatric care face societal and school stigmas, over-medication and faulty diagnoses. In such a complex mental health landscape, it is difficult to assess what resources are available and what works.
Laurie Flynn is the executive director of TeenScreen, a program that has developed a questionnaire to screen young people for severe depression in schools and medical centers. She says that those parties interested in keeping young people from acquiring mental disorders have an important window of opportunity in the teen years. Flynn explains that those with psychological conditions usually start to display symptoms around the age of 14, when teens are entering high school. According to Flynn, untreated mental disorders can translate into more teens entering the juvenile justice system and increased high school dropout rates.
Young people and society both pay a high price for inadequate mental health care. According to a report (PDF) by the National Research Council, an estimated $247 billion a year is spent on social services like child welfare and the juvenile justice system to tackle issues in youth that often stem directly from untreated mental illness. Rosemary Chalk, director of the Board on Children, Youth and Families (BCYF) argues that it is in the public interest to help young people diagnose mental disorders and seek early treatment.
Primary care physicians are often among the first to encounter young people experiencing a mental health crisis. Because a physician's purview is primarily diagnosing conditions and prescribing medications, some are critical of what they see as a resulting over-medication of youth.
"Doctors shouldn't always be looking at this issue with an economic eye, they should be asking themselves, 'Is this the right thing to do?'" says John Genrich, a pediatrician from Colorado Springs, CO. Colorado Springs has one of the highest suicide rates among cities of its size.
Genrich believes primary care doctors should question young people about their mental health, because they may feel more comfortable speaking to a medical professional about these issues than their parents. On the other hand, it can often take a strong parent to become their child's advocate when navigating the many diagnostic and treatment options in the realm of mental health.
"You Can't Put a Village on a Shelf"
Adam Thometz was diagnosed with autism when he was in elementary school. "Since I was one of the special ed students," he explains, "I got teased in elementary school and middle school. I couldn't really stand up for myself." Since his initial diagnosis, he's been through several different schools, programs and doctors.
"We were told by the doctors that Adam was probably going to be institutionalized for the rest of his life," says Adam's father Kurt Thometz. "But we did intuit a glimmer of intelligence that made us question the diagnosis, or at least the inevitability of it."
Thometz enrolled Adam in an "inclusion program" at New York City Lab School, a progressive public school in New York City. Inclusion schools like Lab put special needs students into mainstream classrooms and offer extra help on the side. "I looked at a special education program where he would be thrown in with nothing but other kids with needs," Thometz says, "but I thought that Adam would rise to the level of the kids that he was around." Adam agrees. "The thing about autistic kids," he says, "is they have hidden talents that no one would really expect of us."
Adam was lucky to have a parent who questioned medical professionals' advice and found a school program that was right for him. Many young people lack an adult advocate who can help them navigate the mental health system and explain all the options.
"Youth are vulnerable, and the vulnerable are the ones that get hit by the mental health system," says David Oaks, executive director of MindFreedom International, a mental health human rights organization. "Often, kids and families are misinformed," says Oaks. "They're told by a doctor in a lab coat that they have a chemical imbalance and this is intimidating to families who love their kids and want to help them to get ahead."
According to Oaks, the system is very much oriented to prescribing drugs to "correct" conditions like attention deficit disorder (ADD), depression, schizophrenia, autism and post-traumatic stress disorder (PTSD). According to a survey of recently trained child psychiatrists published in the Journal of the American Academy of Child and Adolescent Psychiatry, only one in ten children seen in their practices was not receiving medication.
"It's very easy to get a psychiatric diagnosis and it's very easy to get a label," Oaks explains. He thinks early labeling and drugging of young people is damaging, as it isolates rather than engages them with the community support that they need. "They say it takes a village to raise a child," Oaks says. "Well, you can't buy a village in a bottle. You can't put a village on a shelf." While outside organizations play an important support role, for others, self-advocacy is the first step toward breaking free from unnecessary drugs and misdiagnosed conditions.
Questioning the Experts
Brandon Chambers, 16, is an Oregon student who has a long history with the mental health industry. At the age of eight, he was diagnosed with attention-deficit hyperactivity disorder (ADHD) and was put on various medications including Ritalin and Prozac. He now works as a youth advocate for the Oregon Family Support Network (OFSN), a program that helps teens navigate the mental health system.
"I think the school wanted me on medication so that they didn't have to deal with me," he reflects. "They wanted me to sit in class and be quiet." He felt that his school did not do enough to support him in his treatment. "There were a couple of meetings with my mom, just informing my mom about how bad I was. I don't believe I ever got a teacher that actually tried to work with me."
22-year-old Chrissy Peirsol works with Chambers at OFSN. She was also diagnosed with ADHD and bi-polar disorder at an early age and was put on various medications. "My mom really didn't care because I was so crazy, she was just like, 'Do what the doctors say.'" Peirsol felt that her mother and the other adults in her life deferred to the recommendations of her doctor without really taking her own opinions on medication into account. "My word had no validity compared to my psychiatrist."
Since she discontinued her medication, Peirsol feels that youth advocacy has been therapeutic: "It's really helped empower me by helping me empower others." Like Peirsol, young people with experience battling mental health stigmas and forced treatment are often the most in-touch advocates.
Martin Rafferty, 22, is another such advocate. As a youth outreach coordinator, he provides counseling for young people involved in the mental health system. He's concerned that programs like TeenScreen are misguided. "The [surveys] are ridiculous," he says. "The kids don't understand the point of the questionnaire and it's not taken very seriously. But that's not how the answers are perceived." Rafferty worries that patients trust doctors too readily and do not question the treatment.
"Society says that if a doctor tells you to take medication, you should." Rafferty thinks that, instead of medicating young patients, doctors should work with families to help young people deal with their feelings. "We need to give young people the chance to work in their community and have real access to positive adult role models," he says. But doctors hastily prescribing meds are just one hurdle young people face in gaining adequate mental health care. Schools also lag behind in giving proper advocacy and information to young people who need support.
Schools and Stigmas
Confronting mental health stigmas on high school campuses is an issue for both students and administrators, says Albert Galves, a former school psychologist from Las Cruces, New Mexico. "We have to get over this idea that there are 'normal' kids and there are 'mentally ill' kids. [Those] who receive the label of mentally ill are told that they are scientifically, chemically, different from their peers, and that they will have that condition for the rest of their lives."
They often end up in special education classes where, according to Brandon Chambers from OFSN, students are almost exclusively taught social skills, falling behind on their academic education. "I spent three years in special ed," he explains. "I'm still really behind on my math skills because of it." He fell behind in fourth grade when he was just nine years old. At 16, he is still working to catch up.
Dealing with the stigma of mental illness and navigating the system to seek appropriate treatment is especially hard in smaller U.S. cities. Yet even in major metropolises like New York City, students requiring mental health care frequently do not receive the treatment they need. Many end up being tracked into special education courses. The NYC Department of Education has invested a lot of energy into assuaging this problem.
In New York City, 135 public schools currently have school-based mental health centers equipped with a staff of social workers, psychologists and psychiatrists who can treat students who either refer themselves, or are referred by parents or teachers. One of these school-based clinics is located at the Martin Luther King, Jr. High School complex in Manhattan, a building that houses six different public schools including Manhattan Theater Lab and the Urban Assembly School for Media Studies.
Behind an inconspicuous door labeled "Hospital-based Health Center" are a nurse practitioner, medical assistant, physician, social worker and two psychiatrists affiliated with St. Luke's hospital. This team works with students but is not a part of the Department of Education. "We get walk-ins, students who come in for their sports physicals or job physicals, or we get referrals from teachers or guidance counselors," explains Paula Comi, a nurse practitioner. "If during my interview with a student I sense that they may have some depression or family problems, I'll refer them to our social worker. If they seem like they may be suicidal, or they may be a harm to others, I'll refer them right away to the psychiatrist."
At the clinic, all interactions between students and doctors are confidential and free of charge to students. The clinic bills Medicaid for any costs they may incur. Students do need to receive parental consent for treatment unless the service pertains to reproductive health. In New York City, students under 18 are able to seek confidential reproductive health services without parental consent. Despite the presence of the clinic on campus, many students are not accessing the services available to them.
Students at Manhattan Hunter Science High School, located on the top floor of the MLK complex, seemed a bit in the dark about the St. Luke's clinic. "I didn't even know it existed," said 17-year-old student Nicholas Alexopoulos. Another student, Alvin Rivera, 16, said he might have utilized the clinic's services if he had known about them when he was having some family troubles last year. "I was going through some stuff and I talked to the guidance counselors at my school, but they seemed like they were really focused on grades. I didn't feel comfortable opening up to them because I didn't really know them," he said. He ended up seeking treatment with his mother at Mount Sinai hospital and says he's doing better now. "I don't know that the clinic would have helped, but it would have been something to try," he said.
At schools lacking clinics, students can get referrals to outside organizations from their health centers or from their principals. "Principals can choose to partner with different community organizations that can help their students," explains Scott Bloom, director of School Mental Health Services -- part of the NYC Department of Education. Funding for these programs comes from various sources including private donors, private insurers and Medicaid reimbursement. According to Bloom, the goal is to get as many schools as possible to offer these comprehensive services on site to increase the chances that a student will receive the help that they need.
A survey (PDF) conducted by the NYC Department of Health and Mental Hygiene in the Bronx shows that out of 100 students who were referred to an outside doctor regarding a mental health issue, only 43 ever received any kind of treatment. "It's great to do screenings," Bloom says, "but you've got to have the resources to back it up."
A good example of Bloom's vision are New York's 21 community schools, which partner with the Children's Aid Society, offering a wide range of social and mental health services (PDF). The schools are primarily located in the Bronx and Washington Heights where the demographic is largely Hispanic and African-American. Children of new immigrants are particularly vulnerable to mental illness because they often experience separation anxiety and social isolation.
Stigma surrounding mental illness is also prevalent in the African-American community. "For many of us, anything other than praying to God is seen as a betrayal," says Terrie Williams, a mental health advocate with the Stay Strong Foundation. She says that in the black community, mental illness is considered a weakness. "We're the strong ones, we're considered survivors," she explains. "That means that you can't go and say that you can't think straight."
She feels that young black men in particular are taught to hide their pain. "They are catching hell every day and we don't pay attention to their pain until it manifests itself outwardly in suicide or school shootings."
Ultimately, the most important factor impacting the mental health of a young person may be whether they have an adult in their life that they trust and with whom they can be open about their feelings.
"Parents set their kids up for a lifetime legacy of emotional pain by trying to protect them, by hiding from them who they really are," Williams explains. "When we're crying, we hide it from our kids. Every time we lie and say we're fine, we're teaching them that that's what you do. You pretend, you wear the mask."
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Amanda Thieroff is a program coordinator at Children's PressLine, a youth media organization that trains youth to be reporters and advocates. She is also an independent writer, radio producer, filmmaker and adventurer. She currently lives in Brooklyn, New York and drives a pedicab around the streets of Manhattan.
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