For the mental health crisis facing our youth, Prevention may be the answer

When it comes to the mental health of our children and teens, research tells a worrisome story: too many of today’s young people are faring poorly.

The Statistics

In a recent study, 13 percent of American youth surveyed between the ages of 12 and 17 reported they’d had at least one major depressive episode in the previous year. That was an increase of 59% from 2007 to 2017. Far more disturbing the number of suicides among young people has jumped significantly over roughly the same period. In 2018, the Centers for Disease Control (CDC) reported that the suicide rate among youth aged 10 to 17 had rose by a shocking 70 percent between 2006 and 2016.

Anxiety is also rampant among America’s children and adolescents. Indeed, as the Psychiatric Times recently reported, “Anxiety disorders are the most common psychiatric condition in youth . . . with a median age of onset of 6 years.” While anxiety might seem less detrimental than depression, these disorders can negatively affect academic performance, social engagement, and family functioning. And according to a report by the Child Mind Institute,

Anxiety is a gateway disorder that leads to increased risk of depression, school failure, substance abuse, and suicide.”

If you work with young people, it’s likely you don’t need studies to confirm what you see on a daily basis: mental health issues among our students have skyrocketed in recent years.

Why Now?

Mental health problems are nothing new. Their causes are and always have been complex. The risk factors include biological and genetic vulnerabilities, socioeconomic disadvantages, family dysfunction, and experiences of trauma. But these factors tend to remain stable over time, and thus they don’t explain the sharp rise we’ve witnessed in recent years. So the question is, why now?

Experts say there are a number of factors contributing to young people’s diminished well-being. The ubiquity of technology and social media play an obvious role. Ample research has shown — and teens themselves report — that social media can have negative effects on self-esteem and overall well-being. The heightened pressure many teens feel to succeed academically is also a contributing factor. According to recent research, 61 percent of teens said they felt “a lot” of pressure to get good grades in school. Another 24 percent said they felt at least some pressure to do well.

Current societal and global concerns may also be contributing to young people’s mental and emotional dis-ease. Frequent school shootings, the global climate crisis, and the increasing violence and polarization in our society take their toll on our kids, particularly in today’s hyper-connected, always-plugged-in world where these realities are hard to avoid.

Many of these conditions are truly unsettling, yet strong coping skills and resilience can equip young people to withstand the stressors inherent in human life and insulate them from the severe mental distress that puts them at risk for more serious mental illness.

But to develop coping mechanisms, many kids need help. According to the U.S. Department of Health and Human Services, roughly one in five children and adolescents experience a mental health problem during their school years, but as many as 60% of them will not receive any treatment.

The High Costs of Impaired Mental Health

It goes without saying that addressing the mental health crisis is of critical importance. The anguish and suffering that result from depression, anxiety, PTSD, and other mental and emotional disorders are great. And while suffering is the most immediate burden, it is not the only one. Other costs include lower academic performance and social engagement, which can lead to fewer opportunities later in life. Untreated mental health issues often become more severe over time, compounding the pain and suffering. And the financial costs to our society are staggering. In 2011, the CDC estimated that the cost of mental disorders to the US economy weighed in at $300 billion! Thus, by every measure, working to improve our youth’s mental health is a benefit for everyone.

Preventing Mental Health Challenges Before They Start

Increasingly mental health experts are looking at prevention as an efficient and cost-effective strategy to address the mental health crisis among people of all ages, and especially among children and teens. Because most mental health problems first become apparent in adolescence, the school years overlap with the prime developmental stages to address and prevent serious mental health issues.

A recent article in the British newspaper The Guardian reported on the growing interest in prevention, referring to it as the new “holy grail” in mental health:

“‘Prevention is much less developed in mental disorders than in other areas of medicine. In psychiatry and psychology it is like we are practicing 1950s cardiology, where you wait for a heart attack and once it happens you know what to do.‘”- Ron C. Kessler, Harvard Medical School

No one would deny that prevention is a highly effective strategy for maintaining physical health. People are much better off cultivating good habits and staying healthy rather than trying to combat illness once it sets in — whether it’s something relatively minor, like a case of the flu or deadly serious, like heart disease.

Experts have begun applying this same principle to mental health. They have found that, whenever possible, it is more effective to prevent mental, emotional, and behavioral issues than it is to treat them. And it is far easier to treat incipient mental health problems than it is to combat and uproot them once they’ve become entrenched.

In an article published in Psychiatry Online, William Beardslee, of the Harvard school of Education, and two colleagues suggest that prevention is an idea whose time has come. “Robust scientific evidence shows that mental, emotional, and behavioral disorders can be prevented before they begin,” they write.

There is an established and growing scientific body of evidence demonstrating methods to prevent mental illness before it starts. These preventive strategies reduce risk factors, enhance protective factors, and practice mental health promotion. They require using universal approaches that address the entire population, selective approaches for people at elevated risk, and indicated approaches for people showing early signs of an illness. Prevention requires a paradigm shift to implementing strategies before the onset of illness and treating the population before waiting for people to come to our door.”

Citing other research, Beardslee and his colleagues argue that during the school years, interventions that support academic development and promote social and emotional skills offer great promise and should be widely implemented.

Prevention in the Schools

It’s clear that schools have a central role to play in addressing the mental health crisis facing our young people — both through treatment and prevention. Why schools? Proximity is one big reason. Between the ages of 6 and 18, children spend the bulk of each day at school. School is the place where they are seen and known, where problem behaviors can be identified, and where interventions can take place.

Access is another big reason. For many families, barriers exist that prevent them from accessing mental health interventions for their children. In a statement published in the journal Pediatrics, the Committee on School Health writes, “Many families will not address their mental health needs if their health insurance does not offer adequate coverage. Additional barriers include lack of transportation, financial constraints, child mental health professional shortages, and stigmas related to mental health problems.”

The Committee advocates school-based mental health services to meet the needs of young people — both for those who may already be experiencing difficulties and to prevent problems from arising in the first place: “One way to categorize components of a school or district’s mental health program is to consider a 3-tiered model of services and needs. The first tier is an array of preventive mental health programs and services. Activities in this tier need to be ubiquitous so that they target all children in all school settings.”

Instilling literacy in students is a big part of our schools’ educational mandate. But experts are increasingly recognizing the need for “mental health literacy” among our young people. In a study that was first published in the journal American Psychologist and later reported in U.S. News and World Report, researcher Anthony Jorm writes, “Schools, colleges, and universities are well placed as settings for improving mental health literacy because of the high-risk age groups they serve and their educational mission.” In his research, Jorm cites three small studies which demonstrate that students benefited from being taught about mental health. As a result, their attitudes toward mental health treatment improved, and they were more willing to seek help from a counselor themselves.”

One of the great benefits of this and other preventive strategies is that they take the stigma out of mental health problems, and thus they make young people more willing to ask for and receive the help they need.

“The mental health problem is one of epic proportions. To think that this can be handled outside of school is a false assumption. We need to address it right where the students are. It’s a challenge that is going to take resources and that teachers are unprepared for at this point. But it’s a challenge we can’t ignore.”- Amy Kennedy, Education Director at the Kennedy Forum

Reinventing K-12 Mental Health Care. Effective School Solution partners with school districts to help develop K-12 whole-school mental health programs.

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