3 innovations to improve mental health treatment

Our nation has recently witnessed another tragedy involving a young adult, with young adult victims. Facts often emerge slowly and it is important not to speculate about diagnoses through the news media; however, it seems clear in this case that mental illness is a factor — even though few people living with mental illness are violent.

To avoid tragedies, solutions are needed.  One area of real promise is early intervention — before crises occur. Mental illnesses are diseases that strike early: The symptoms for approximately 50 percent of lifetime cases appear by age 14 and 75 percent by age 24. It can take as long as eight to 10 years to get people with mental health issues to get the treatment they need.

One in five children struggle with mental health conditions and suicide is the third leading cause of death for people ages 10 to 24. It’s critical that we focus on children and youth who are vulnerable and may face delayed access to mental health treatment.

Despite the increase in public awareness of childhood mental health issues, stigma continues to exist as a barrier to care. During this delayed access, children are missing critical developmental milestones, experiencing school failures, social isolation, family distress, or, in particularly tragic cases, attempting or completing suicide.  Families confronting mental illness often do not know where to turn for advice or struggle to find an appropriate and available mental health care provider.

However, amidst the turmoil, there is hope. Many successful, innovative approaches have emerged in pockets of local communities across the country. The National Alliance on Mental Illness and Cigna have identified three key, no-nonsense, cost-effective innovations that should be examined for replication nationwide.

First, we need to ensure that mental health services are available to young people where they are every day – in schools. Bringing mental health prevention and early intervention into schools makes perfect sense. School-linked mental health programs make it possible for children and families to receive help in a familiar, non-stigmatized setting where professionals have an opportunity to really know and understand the children they serve.  In addition, schools must know how to recognize signs and symptoms early and assist youth and families in getting appropriate help.

Second, addressing the mental health of children in primary care, including screenings, is key to ensuring that children with mental health needs are identified and linked with services.  There are many barriers to early identification, intervention and care for young people with mental health conditions including a shortage of mental health services and providers. With the majority of children and youth in the regular care of pediatricians, conversations, as well as effective early identification and treatment should routinely take place in primary care settings with referral to specialty care.

Third, we need to promote intensive, youth-friendly mental health services that effectively engage young people. The National Institute of Mental Health has researched a package of services for youth focusing on employment and education along with family support and treatment. These intensive services get young people with serious mental health conditions on the right track. Mental health crisis services are also needed for those with the most serious conditions.

These solutions leverage what matters most to youth – relationships, school and work — while also recognizing the important role that families and schools play in the lives of children.  It’s time to take action to ensure a better future.

Mary Giliberti is executive director, National Alliance on Mental Illness. Stuart Lustig is lead medical director, child and adolescent care, Cigna Behavioral Health and associate clinical professor, department of psychiatry, University of California, San Francisco.  This article originally appeared in the Washington Post

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  • ninguem

    The biggest innovation might be to pay for the treatment.

    • DeceasedMD

      The only problem with that is there are no more psych hospitals left.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        The Washington Post is owned by Amazon now, that’s how.

  • DeceasedMD

    So glad Cigna has the answer.

    • guest

      And that it’s “cost effective!” Because everyone knows that those “cost-effective” solutions are always so…effective.

  • guest

    Funny, I didn’t see anything in there about Cigna planning to pay pediatricians more for the extra time that doing a mental-health screening during a well-child visit will take…

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    And why are the shootings mentioned right at the start, if we shouldn’t speculate, and if very few mental illnesses trigger violence? Because the marketing guys said that it should be there….?

    I actually find this rather unusual Salon article from Jim Sleeper to be much more insightful than the customary tinkering on the edges… http://www.salon.com/2014/07/04/we_the_people_are_violent_and_filled_with_rage_a_nation_spinning_apart_on_its_independence_day/

  • DeceasedMD

    Please do tell more. i think it seems pretty hopeless as clearly there are reasons why the public and govt do not fund mental health. -except in prisons….

  • JR DNR

    We already see how badly schools bungle this up:

    1. Tell parents their children need to be evaluated for ADHD
    2. Large numbers of children being placed on ADHD medication

    I personally do not want the school system involved with children’s health anymore than I want employers involved in health.

    You also don’t define mental illness. Are you going by the DSM-V where life’s normal ups and downs become “mental illnesses”? Are we talking about those with very clear paranoid hallucinations only are are we talking about everyone who gets “sad” about something?

    You also don’t define treatment. Are we talking about funding support groups and social services (awesome), or drugging up everyone who is struggling with life (ineffective)?

    • James O’Brien, M.D.

      DSM-5 is a political document and pseudoscientific farce. And it’s not just my opinion, it’s the opinion of Allen Frances, M.D. who was the author of DSM-4.

  • JR DNR

    I know someone who got a job working with disturbed youth in an institutionalized setting a few months ago.

    At first, she had a lot of trouble adjusting, but now she believes that the children “want” to be restrained because that is what they teach new employees. From her description, these children and teenagers have zero control in their life. For example, they are forced to shower every day, and must lather up, allow someone to look at them to verify they have used soap (only covering their bodies with their hands), before they rinse off. When children have no control in their life, they’ll control whatever they can: things like vomit and bowel movements. And that’s exactly what these kids are doing and she “doesn’t understand why they are so irrational”.

    Average turnover at the facility is 7 months, and the workers they are hiring are not being trained in how these kids think or work, rather they are being taught that strict discipline, restraint, and isolation rooms are in the kid’s best interest.

    We don’t screen for diseases unless we have effective treatment for them. We don’t have curative treatments at this time, heck, we don’t even know what’s actually wrong.

  • James O’Brien, M.D.

    As a forensic psychiatrist, I am against mandatory mental health screening and even a lot of what passes for mental health intervention by schools, who have a financial interest in labeling kids. Even though it would be a boondoggle for me financially, ethically and scientifically it is fraught with problems. There are way too many false positives and there are major problems with construct validity of DSM diagnoses. We’ve already done enough damage with schools being overly involved and compensation for ADHD overdiagnosis. Many of those diagnosed are simply the youngest boys in the class. This is even more of a problem with parents holding their kids back and those who don’t will be likely to be misidentified.

    http://consumer.healthday.com/kids-health-information-23/attention-deficit-disorder-adhd-news-50/youngest-kids-in-class-may-be-more-likely-to-get-adhd-diagnosis-670784.html

  • guest

    Oh, good! Are they going to get the coaches to do the screenings for mental illness like they do the scoliosis screening? The last thing we need are more uneducated folks pretending to practice medicine. It seems like just yesterday when I was sent home with an urgent letter warning of the curvature of my spine compliments of the scoliosis screening performed by some goofball coaches. My mom called a doctor friend, and he was completely disgusted with their assessment. He said it was nothing to worry about, and they didn’t have clue what they were doing. I already had a pediatrician. I didn’t need a scoliosis assessment done by a school coach.

    Mental illness screening in schools. Just another really bad idea.