Last
Updated Introduction
The 2002 General Assembly, through Senate Joint Resolution
99, directed the Virginia Commission on Youth to coordinate the collection
and dissemination of empirically-based information that would identify the
treatment modalities and practices recognized as effective for the
treatment of children[1],
including juvenile offenders, with mental health treatment needs, symptoms
and disorders. This initiative
originated from recommendations made to the 2002 General Assembly by the
Virginia Commission on Youth as part of a two-year study of Children and
Youth with Serious Emotional Disturbance Requiring Out-of-Home Placement
and by the Committee Studying Treatment Options for Offenders with
Mental Illness or Substance Abuse Disorders
(House Document 23, Senate Document 25, respectively). Background of Children and
Adolescents’ Mental Health The recognition that children and adolescents suffer from
mental illness is a relatively recent occurrence.
Throughout history, childhood was considered a happy period.
Children were not thought to suffer from mental disorders or
emotional distresses due to the notion that they were spared the stresses
that plague most adults (American Psychiatric Association, 2002).
It is now well-recognized that these disorders are not just a stage
of childhood or adolescence, but a result of genetic, developmental and
physiologic factors. Research
conducted in the 1960’s revealed that children suffer from mental
disorders (American Psychiatric Association, 2002).
It was not until the third edition of the DSM (the Diagnostic and
Statistical Manual of Mental Disorders) of the American Psychiatric
Association in 1980 that child and adolescent mental disorders were
assigned a separate and distinct section within the classification system
(National Institute of Mental Health, 2001).
The development of treatments, services and methods for preventing
mental disorders in children and adolescents has also gradually evolved
over the past several decades. The National Alliance for the Mentally Ill (NAMI) defines
mental illness as a disorder of the brain that may disrupt a person’s
thinking, feeling, moods, and ability to relate to others (NAMI, 2002).
Mental disorders and mental health problems appear in families of
varying social classes and backgrounds.
However, there are children who are at greatest risk due to other
factors. These include:
physical problems; intellectual disabilities (retardation); low birth
weight; family history of mental and addictive disorders;
multigenerational poverty; and caregiver separation or abuse and neglect
(U.S. Department of Health and Human Services, 1999). Woodruff, et. al (1999) have indicated that, to date, child and adolescent mental health has emerged as a distinct arena for service delivery, drawing on the philosophies and practices that characterized other childhood fields, such as early intervention. With the increase in attention given children’s mental health and the development of systems of care for children with serious emotional disorders and their families in the last two decades, mental health is emerging as a new focus in the field of early childhood (Woodruff, et. al, 1999). Family members, practitioners, and researchers are becoming increasingly aware that mental health services are an important and necessary support for young children who experience mental, emotional, or behavioral challenges and their families. Table
1 °
Biological
Influences °
Psychosocial
Influences °
Family
and Genetic Factors °
Stressful
Life Events °
Childhood
Maltreatment °
Peer
and Sibling Influences
Source:
Austin/Travis County Community Action Network - Prescription for Wellness, National Institute of Mental Health, 2000. Prevalence
of Mental Disorders among Children and Adolescents Clearly,
the widespread prevalence of mental illness in children and youth has been
established. According to
estimates compiled by the Center for Mental Health Services, 11 percent of
children in the Although
the awareness of children’s mental health issues has developed,
knowledge about treating disorders is still emerging.
According to the American Psychiatric Association (APA), 12 million
American children suffer from mental illness; however, only one in five
receives treatment (American Psychiatric Association, 2002). In
1999, as reported by Jenson (2002), the Office of the Surgeon General
indicated that only 30 percent of all children with a mental or emotional
disorder were receiving treatment. Only
one in three to five children receive any specialty mental health
services. Finally, for
children meeting the criteria for serious emotional disturbance, school
systems are the only provider of services for 50 percent. In
Meeting
the Need for Treatment Acknowledgment of children’s and adolescents’ mental
health needs has prompted further study of the specific disorders that
plague this group, as well as the interventions utilized for treatment.
Increased activity in this area can be directly attributed to the
1999 Surgeon General's Report Mental Health: A Report of the Surgeon
General. This report
includes a chapter on children and adolescents and is the first such
report to reference mental health. A
follow-up effort was released one year later, entitled A Report of the Surgeon General's Conference on Children's Mental
Health: A National Action Agenda.
This publication set the tone for policy and research for
children’s mental health. Another
recent federal initiative that is closely aligned to the philosophy and
findings set forth in the Surgeon General’s Report is the 2001 NIMH Blueprint
for Change: Research on Child and Adolescent Mental Health. The Surgeon General’s Report outlines the importance of
mental health in children and the view that the treatment of mental
disorders should be a major public health goal.
In the National Action Agenda, the Surgeon General asserted that
three steps must be taken to improve services for children with mental
health needs: improving early recognition and appropriate identification
of disorders within all systems serving children; improving access to
services by removing barriers faced by families; and closing the gap
between research and practice, ensuring evidence-based treatments for
children (U.S. Department of Health and Human Services, 1999). The Surgeon General’s Report also specifies the need for
utilizing scientific evidence for mental disorders and describes a system
plagued by treatment barriers, including stigma, discriminatory health
insurance practices and the unavailability of appropriate services. Other
guiding principles are that 1) families should be involved as full
participants in all aspects of the planning, delivery and evaluation of
services and supports and 2) treatments should be sensitive and responsive
to racial, ethnic, linguistic and cultural differences. Other important
features include improving or remedying environmental factors that put
children at risk for developing mental, emotional or behavioral problems. Without appropriate treatment, these childhood mental
disorders can lead to more
serious mental disorders. Untreated
childhood disorders can also be predictors of other future difficulties,
such as increased potential for involvement in the juvenile justice
system, the loss of custody and even placement outside of the home. Less serious outcomes
include other destructive, ambiguous or dangerous behaviors and mounting
parental frustration. The
Surgeon General's efforts encourage further testing and refining of
programs in a real-world context. A
preventive and developmental approach to children's mental health problems
must be taken. While many
programs try to provide coordinated care for children with mental health
needs, the children's mental health system remains splintered.
The principle that mental health is an essential part of children's
health is emphasized throughout this report. Sources American
Psychiatric Association. (2002). Childhood
Disorders. [Online]. Available: www.psych.org/public_info/childr~1.cfm.
[June 2002]. Austin/Travis
Jensen,
P.S. (2002). Closing the Evidence-Based Treatment Gap for Children’s
Mental Health Services: What
We Know vs. What We Do? Emotional
and Behavioral Disorders in Youth. National
Alliance
for the Mentally Ill.
Virginia
(2002). General
Information. [Online]. Available: http://www.namivirginia.org/toppage1.htm.
[June 2000]. National Institute of Mental Health. (2001). Blueprint for Change: Research on Child and Adolescent Mental Health. Report of the National Advisory Mental Health Council’s Workgroup on Child and Adolescent Mental Health Intervention. U.S. Department of Health and Human Services. (1999). Mental Health: A Report of the Surgeon General. Rockville, MD.
U.S.
Department of Health and
Human Services. (2001). Report of
the Surgeon General’s Conference on Children’s Mental Health: A
National Action Agenda.
Virginia
Commission on Youth.
(2002). House Document 23. Youth
with Emotional Disturbance Requiring Out-of-Home Treatment. Virginia Joint Behavioral Health Care Commission. (2002).
Senate Document 25. Treatment Options for
Offenders Who Have Mental Health Needs.
Virginia
Department
of Mental Health, Mental
Retardation, and Substance Abuse Services. (2001). Woodruff,
D.W., Osher, D., Hoffman, C.C., Gruner, A., King, M.A., Snow, S.T., and
McIntire, J.C. (1999). The role of education in
a system of care: Effectively serving children with emotional or
behavioral disorders. Systems of Care: Promising Practices in Children’s Mental Health, 1998
Series, Volume III. Resources Mental
Health: A Report of the Surgeon General www.surgeongeneral.gov/library/mentalhealth/chapter3/sec6.html National Institute for Mental Health (NIMH) National Alliance
for the Mentally Ill
(NAMI)
American
Academy
of Child and
Adolescent Psychiatry [1]
Child and children are used throughout this document to connote children
and adolescents.
|