The initiative represents a massive undertaking, involving seven commissions of top-flight scholars from around the United States and Europemore than 100 altogether. Each commission addressed a different issue: mood disorders (including bipolar), schizophrenia, anxiety disorders, eating disorders, alcohol and drug abuse, suicide, and positive psychology, which could be viewed as the anti-disorder. Five of the seven are led by Penn faculty members, and Penn is represented on all commissions.
They have produced a prodigious amount of resource material, including a definitive, 800-page tome, Treating and Preventing Adolescent Mental Health Disorders: What We Know and What We Don’t Know, which was named the best book in clinical medicine in 2005 by the Association of American Publishers. (It can be viewed online at http://amhi-treatingpreventing.oup.com/anbrg/public/index.html.) Then there are the four resource books for parents and eight firsthand accounts of teenage mental illness (see sidebar on p. 43), all edited by Patrick Jamiesonwho also oversees a website for teens, CopeCareDeal (see sidebar on p. 38).
The abundance of material is a response to a problem whose severity is not always recognized. As Dr. Dwight Evans, chair of the Department of Psychiatry and head of the AMHI’s commission on adolescent depression and bipolar disorder, puts it: “Mental illness really is the chronic disease, or diseases, of the young.”
Suicide is the third leading cause of death among youth (behind only car accidents and homicide). More than one out of every 12 of high-school students have attempted it in the past year, and each year roughly 4,000 young people (ages 15 to 24) succeed in killing themselves. “Mental illness underlies the majority of suicides,” notes Dr. Daniel Romer, director of the ARCI.
Between 20 and 30 percent of adolescents report “clinically significant” symptoms of depression. The mean age of onset is 15.
An estimated 1.1 million teenagers (ages 12-17) needed substance-abuse treatment in 2001. (More than half of all high-school students have used an illegal drug by the time they graduate.) Only 100,000 actually received treatment.
Schools, the main service-delivery system for 70 to 80 percent of adolescents with mental-health issues, are seldom equipped to deliver the services needed. Nearly half of the 2,000 schools surveyed by the AMHI lacked full-time access to a mental-health professional. “It’s amazing to me how little teachers, even in national conventions, know about the various mental illnesses,” says Dr. Raquel Gur M’80 GM’84, the Rickles Professor and vice chair for research development in psychiatry who headed the AMHI’s commission on schizophrenia. “They’re more familiar with ADD, and how [students] are progressing according to the growth charts.”
Primary-care physicians are often inadequately trained to identify and diagnose mental-health problems, and “report low confidence in their ability” to do so, according to an AMHI study.
The recent tragedy at Virginia Tech is a grim reminder of the possible consequences for untreated or ineffectually treated mental illnessthough only a small percentage of the mentally ill commit acts of violence. “Every time I see a news article in which a killer, or someone who was shot and killed by police, or someone who died by suicide is listed as having bipolar disorder, I remind myself that there are nearly two million of us with bipolar in the United States,” notes Patrick Jamieson. “That’s a lot of peopleand very few of them have violent histories.”
Most mental-health disorders first “present” (to use the medical lexicon) during adolescence, which the authors of Treating and Preventing define broadly as ages 10 to 22. Left untreated, those disorders can become permanent, unwanted guests. Using a metric called Disability Adjusted Life Years, which measures the morbidity of a disease, the World Health Organization recently “ranked depression as No. 4 worldwide in terms of disability,” notes Evans. By 2020, “depression alonenot anything else; just depressionwill be No. 2 worldwide behind ischemic heart disease. Because these disorders begin so early, they do have significant morbidity and mortality associated with them.”
There’s a “lot of well-respected epidemiologic data” linking depression to different illnesses, Evans adds. “We often say depression is bad for the brain, and it’s bad for the body.”
Thanks to medications and psychotherapynot necessarily in that orderdepression, anxiety, and a number of other mental illnesses are treatable. Yet in many places it is harder to get an accurate diagnosis and good treatment for bipolar disorder than it is for, say, diabetes. Especially when co-morbidityoverlapping disordersenters the mix, which it often does.
“Experts are aware of the fact that we know very little about adolescents” when it comes to mental illness, says Dr. Edna Foa, the professor of clinical psychology in psychiatry and director of Penn’s Center for the Treatment and Study of Anxiety who headed the AMHI’s commission on anxiety disorders. “We know a lot about adults, especially in anxiety disorders; some about children; and we know next to nothing about adolescents. That still is the caseI think because, for a while, we thought maybe adolescents are like little adults or like big children. We didn’t think about them as having very specific issues that make their stress issues very unique.”
Even when mental illness is properly diagnosed, the logistics of getting treatment for it can be dauntingespecially since “at least six separate sectors or administrative structures may be involved in serving youth with mental health problems,” according to Treating and Preventing. Though one important national programthe Comprehensive Community Mental Health Services for Children and Familiesreceives close to $100 million in federal funding, it only reaches a “small percentage of communities” in the U.S. Most families seeking mental-health care thus face “significant system barriers” to effective treatment.
“You could produce a whole movie on adolescent and child mental-health care that in some ways would easily be more startling than Sicko,” says Dr. Charles O’Brien GM’69, the Appel Professor and Vice Chair of Psychiatry (and director of the Center for Studies of Addiction at Penn), referring to Michael Moore’s documentary about the health-care industry. “Even here in Philadelphia, it’s very hard to find treatment slots for children and adolescents,” adds O’Brien, who headed the AMHI’s commission on substance abuse. “There are problems with service delivery and problems with the knowledge base.”
Not to mention with funding and insurance coverage: Nearly 12 percent of those under 18and 30 percent of those between 18 and 24have no health-insurance coverage whatsoever. And those who have health insurance are by no means guaranteed payment, since parity for mental-health issues remains an elusive goal.
“We have interventions that actually work, but now we’ve got a category that says this is ‘mental’ as opposed to ‘physical’and as a result you don’t get access to the things that work,” says Kathleen Hall Jamieson. “That’s the part of society that’s broken right now in the United States, and it would be good to find a way to get it fixed. My husband and I are upper class; we’re educated; we’re tied into a major research university; we had insuranceand it was difficult for us. Imagine what it would be for someone who doesn’t fall into those categories. That ought to be troubling to society. It’s certainly troubling to us.”
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©2007 The Pennsylvania Gazette
Last modified 8/30/07