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Home , Adolescent Health, Adolescent medicine

FA C T S f o r P o l i c y m a k e r s

Adolescent in the United States

Susan Wile Schwarz June 2009

Vulnerable Teens

Adolescence is a critical period for to and more likely to mental, social, and emotional well- engage in risky and thrill-seeking being and development. During behaviors than either younger , the brain undergoes children or adults. These and significant developmental changes, other factors underline the im- establishing neural pathways and portance of meeting the mental, behavior patterns that will last social, and emotional health into adulthood.1 needs of this age group.

Because their brains are still Mental health and social and emo- developing, adolescents are par- tional wellbeing – combined with ticularly receptive to the positive sexual and , influences of development and unintentional , strategies, social and emotional substance use, and and learning, and behavioral model- – form part of a complex ing.2 3 But adolescents’ developing web of potential challenges to brains, coupled with hormonal adolescents’ healthy emotional changes, make them more prone and physical development.4

Facts about Adolescent Mental Health

♦ Approximately 20% of adoles- – For a quarter of individuals cents have a diagnosable mental with mood disorders like health disorder.5 depression, these first emerge 8 ♦ Many mental health disorders during adolescence. first present during adolescence.6 – Between 50% and 75% of ado- – Between 20% and 30% of lescents with disorders adolescents have one major and impulse control disorders 215 W. 125th Street, 3rd Floor (such as conduct disorder or New York, NY 10027-4426 depressive episode before they reach adulthood.7 attention-deficit/hyperactivity Ph. 646-284-9600 disorder) develop these dur- www.nccp.org ing adolescence.9 ♦ is the third leading Suicide rates by age and gender, ages 10-18, 2006 cause of death in adolescents 10 0.17 and young adults. Ages 10 to 12 * 0.69 – Suicide affects young people 1.82 Ages 13 to 15 from all ages, races, genders, 3.69

and socioeconomic groups, 2.63 Ages 16 to 18 although some groupsseem to 10.99 11 have higher rates than others. 0 2 4 6 8 10 12 Deaths per 100,000 – Older adolescents (aged 15- 19) are at an increased risk for suicide (7.31/100,000).12 Suicide rates by race/ethnicity* and gender, ages 10-18, 2006 – Between 500,000 and one mil- Asian/ 1.15* lion young people aged 15 to Pacific Islander 3.77 24 attempt suicide each year.13 Hispanic 1.35 ♦ Existing mental health prob- 3.23 lems become increasingly Black/ 0.65* complex and intense as children Non-Hispanic 3.43 transition into adolescence.14 White/ 1.74 Non-Hispanic 6.08 ♦ Untreated mental health prob- American Indian/ 9.73* lems among adolescents often Alaskan Native 19.98 result in negative outcomes. 0 5 10 15 20 Deaths per 100,000 – Mental health problems may lead to poor school per- Females Males formance, school dropout, strained family relationships, involvement with the child wel- * Rates based on 20 or fewer deaths may be unreliable. Source: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. fare or juvenile justice systems, Web-based Injury Statistics Query and Reporting System (WISQARS). www.cdc.gov/ncipc/wisqars. , and engaging in risky sexual behaviors.15 – An estimated 67% to 70% of youth in the juvenile justice system have a diagnosable mental health disorder.16

System-level Challenges to Attaining Adolescent Mental Health

Between 25% and 33% of ado- adolescents lag behind that of – Nearly half of State Child lescents forgo needed care,17 and other children.19 Health Insurance Program 18 many others lack access. Below – Among adolescents with (SCHIP) programs place are some of the factors hindering limits on inpatient and outpa- mental health needs, 70% do 22 adolescents’ uptake of or access not receive needed care.20 tient mental health services. to programs and services that can ♦ ♦ Lack of referral services and help reduce the risk of mental Lack of adequate insurance coverage: specialists trained in dealing health problems: with adolescents’ specialized ♦ Lack of access and utilization: – Adolescents represented more needs: than 25% of the estimated 8.3 – Health and health-related ser- million uninsured children in – Of the 213 accredited pe- vices access and use among 2005.21 diatric residency training Adolescent Mental Health in the United States

programs in the U.S., only ♦ Lack of confidentiality: 25 have programs – Laws in only 20 states and in adolescent , 7 of the District of Columbia give which include interdisciplin- 23 minors explicit authority to ary training. consent to outpatient mental ♦ Lack of stable living conditions: health services.27 – Rates of serious mental health – There is a high prevalence of disorders among homeless depressive symptoms, suicidal youth range from 19% to 50%.24 thoughts, and suicide attempts – Homeless youth have a high among adolescents who forgo need for treatment but rarely care due to confidentiality 28 use formal treatment pro- concerns. grams for medical, mental, and substance use services.25 26

Recommendations

A well-financed health prevention ♦ Finance effective, empirically- Cultural differences between and response system that fosters based prevention and early patient and provider can lead to communication and cooperation intervention strategies for misdiagnosis of major mental across sectors can provide adoles- health and behavioral health illness,36 while ethnic and gender cents better access to high quality in schools. At least $700 billion matching has been shown to resources that are responsive to is spent annually in the United lead to lower dropout rates in their unique mental health needs. States on preventable adoles- mental health treatments.37 32 In order to achieve this, federal cent health problems. ♦ Establish local, state, and and state governments should: ♦ Finance effective, empirically- national targets for expand- ♦ Fund programs for adoles- based programs to ing the number of adolescent cents that foster improved help parents recognize men- specialists in primary health, decision-making skills and tal health problems in their mental health, behavioral provide positive models for children. When parents lack health, and addiction strate- behavior to reduce risk-taking knowledge of teens’ mental gies. Data show that less than behaviors. Adolescents are health problems, obtaining 1% of primary care particularly resourceful and services may be difficult.33 who may see adolescents are resilient and respond well to ♦ board-certified specialists in Pass legislation to enhance 38 positive engagement strategies confidentiality protection to adolescent medicine. that help provide a social sup- ♦ 29 improve adolescents’ access to Institute financing mecha- port structure. confidential services. Incon- nisms to support necessary ser- ♦ Provide funding to replicate sistent and unclear policies vices, especially in venues that comprehensive school-based regarding adolescent patient increase access, such as schools, health centers throughout the confidentiality can create addi- youth centers, and adolescent- state, particularly those that tional barriers to mental health specific health and wellness provide mental health services. care.34 Only 45% of adolescents centers. Insurance restrictions, Access to on-site, school- surveyed would seek care for poor funding, and low priori- based mental health services depression if parental notifica- ties for resources are among the in school-based health centers tion were required.35 key obstacles impeding access increases the likelihood that ♦ Provide funding to attract, train, of children and adolescents to adolescents will receive mental the services necessary to treat 30 31 and retain a more diverse work- 39 40 41 health services. force of providers. mental health disorders. Endnotes

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Children’s Mental Health Statistics, Mental Journal of Adolescent Health 22: 271-277. Health America. Mental Health America website. 27. Boonstra, H.; Nash, E. 2000. Minors and the www1.nmha.org/children/prevent/stats.cfm Right to Consent to Health Care, The Guttmacher (accessed March 31, 2009). Institute. www.guttmacher.org/pubs/tgr/03/4/ gr030404.pdf (accessed April 6, 2009). 14. Patel, V.; Flisher, A. J.; Hetrick, S.; McGorry, P. 2007. Mental Health of Young People: A Global 28. Lehrer, J.A.; Pantell, R.; Tebb, K.; Shafer, Public-health Challenge. Lancet 369(9569): 1302-13. M.A. 2007. Forgone Health Care Among U.S. Adolescents: Associations Between Risk 15. Kapphahn, C.; Morreale, M.; Rickert, V.; Characteristics and Confidentiality concern. Walker, L. 2006. Financing Mental Health The author thanks Lola Adedokun, Ayana Journal of Adolescent Health 40(3): 218-226. Services for Adolescents: A Position Paper of Douglas-Hall, and Rachel Masi for their 29. Masten, A. S. 2007. Competence, Resilience, the Society for Adolescent Medicine. Journal of contributions in writing this fact sheet. Adolescent Health 39: 456-458. and Development in Adolescence: Clues for Pre- vention Science, from Adolescent Psychopathology 16. Skowyra, K. R.; Cocozza, J. J. 2006. Blueprint and the Developing Brain: Integrating Brain and for Change: A Comprehensive Model for the Prevention Science. D. Romer; E. F. Walker (eds.), This fact sheet is supported by a generous Identification and Treatment of Youth with New York: Oxford University Press. grant from The Atlantic Philanthropies.