Wed YouthMentalHealth Helbing

Youth Issues in Mental Health: 

Youth Issues in Mental Health Developed and Presented by: Joan Helbing Diagnostician helbingjoan@aasd.k12.wi.us

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Important Facts About Mental Illness and Recovery: Mental illnesses are biochemical brain disorders that can interfere with a person’s ability to think, feel, and interact with or relate to other people and the environment.   They cannot be overcome through "will power" and are not related to a person's "character" or intelligence. Brain disorders fall along a continuum of severity. The most serious and disabling conditions affect 3-5 million children ages five to seventeen (5 – 9%) in the United States.   

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Mental illnesses strike individuals in the prime of their lives, often during adolescence and young adulthood. All ages are susceptible, but the young and the old are especially vulnerable.

Studies Show MI Often Begin in Youth, Treatment Delays Worsen Issues: 

Studies Show MI Often Begin in Youth, Treatment Delays Worsen Issues One-half of all life-time cases of mental illness begin by age 14, and despite effective treatments for the disorders, there are long delays between the onset of symptoms and seeking treatment. These treatment delays- which can span decades- lead to more severe and difficult-to-treat illnesses and to co-existing disorders.

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Once people do get treatment, few receive care that meets “minimally accepted standards” for mental health treatment. Anxiety disorders often begin in childhood, mood disorders in later adolescence and substance abuse in the early 20’s. Three-quarters of all lifetime cases begin by age 24!

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Researchers say children are less likely to receive timely treatment because they rely on parents or other adults to recognize symptoms, but adults often miss the signs unless they are extreme. Nearly ½ of those who have one mental disorder have one or more additional disorders. The more disorders a person has the more severe each may be.

Washington University research showed that mental illness is now the leading reason for hospitalization of people ages 5-19.: 

Washington University research showed that mental illness is now the leading reason for hospitalization of people ages 5-19.

Many of these families of these children have inadequate health insurance, which does not provide coverage for the intensive counseling, therapy and medication that is often needed by these youth.: 

Many of these families of these children have inadequate health insurance, which does not provide coverage for the intensive counseling, therapy and medication that is often needed by these youth.

Causes Are Complicated: 

Causes Are Complicated Mental health disorders in children and adolescents are caused mostly by biology and environment. Biological Genetics Chemical imbalances Damage to central nervous system Head Injury Environmental Exposure to environmental toxins Exposure to violence Stress due to chronic poverty or other hardship Loss

What’s the Big Deal?: 

What’s the Big Deal? 10% of children and adolescents in the United States suffer from serious emotional and mental disorders that cause significant functional impairment in their day-to-day lives at home, in school and with peers (Mental Health: A Report of the Surgeon General, 1999).

Extent of Mental Disorders in US: 

Extent of Mental Disorders in US ADHD = Attention Deficit Hyperactivity Disorder PDD = Pervasive developmental disorders Sources: Office of the Surgeon General and the national Institute of Mental Health 1999

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Without treatment the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives; The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States.

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The best treatments for serious mental illnesses today are highly effective; between 70 and 90% of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports; Early identification and treatment is of vital importance; By getting people the treatment they need early, recovery is accelerated and the brain is protected from further harm related to the course of illness.

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Stigma erodes confidence that mental disorders are real, treatable health conditions. We have allowed stigma and a now unwarranted sense of hopelessness to erect attitudinal, structural and financial barriers to effective treatment and recovery. It is time to take these barriers down!

Top 3 Leading Causes of Death in Teens: 

Top 3 Leading Causes of Death in Teens Accidents Suicide: depression is the leading cause of loss of functioning Homicide

Illness Development: 

Illness Development Gradual development over time. Child may start with another diagnosis, most often AD/HD or ODD. Sudden onset. Normally developing child develops significant difficulty within a short period of time.

Impact: 

Impact MI’s cause not only emotional but cognitive* problems. Problems with thinking clearly, paying attention and remembering are primary problems of Schizophrenia and affective disorders. *thinking skills

Data on Poor Outcomes for Children with Ineffective Treatment or no Treatment at All: 

Data on Poor Outcomes for Children with Ineffective Treatment or no Treatment at All School drop out and failure (50% - highest rate of any disability group); Juvenile Justice Involvement (70% of youth in the JJ system have 1 or more psychiatric illnesses);

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Youth Suicide (3rd leading cause of death in youth ages 15 to 24); it’s 2nd in Wisconsin! Loss of critical development years, with the failure to develop social skills, friendships and the opportunity to lead productive adult lives.

EBPs for Mental Illnesses in Children: 

EBPs for Mental Illnesses in Children There are a number of evidence-based psychosocial interventions and medications for children and adolescents living with mental illnesses. There are also a number of home and community based service interventions that have proven to be effective for children with mental illnesses and their families.

Treatment Barriers: 

Treatment Barriers Insurance parity Early identification Provider shortage: Four times more child and adolescent psychiatrists are needed to treat children with MI. Fragmented services, overly complex and bureaucratic systems Stigma

Treatment Options: 

Treatment Options Educational Psychological Behavioral Medical

Educational Considerations: 

Educational Considerations predictability of routines structure opportunity for choice shorter work periods lower student-teacher ratio individualized instruction frequent teacher check-backs motivating and interesting curricula use of positive reinforcers

Psychological Support: 

Psychological Support The child may need professional support to better understand his disorder and impact on his life. The family may need support to learn how to be supportive of this child who presents many challenges.

Behavioral Support: 

Behavioral Support Positive behavioral interventions can and do make a difference for many children with brain disorders. Special strategies may be utilized at school to help the child. These strategies may be help- ful at home as well.

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Medication Considerations *Control Symptoms, do not cure *Response varies *Duration may be temporary, indefinite, or intermittent *Some medications must be taken over time to reach therapeutic level *All medications have side effects *Monitoring is essential *Medications have a variety of applications and may be used for different reasons

Why are EBPs Important?(Evidence-Based practice): 

Why are EBPs Important? (Evidence-Based practice) EBP treatment and services improve outcomes for children and families. They have been shown to: Improve school performance and attendance; Improve peer and family relations; and Reduce the symptoms of mental illnesses in children. Presentation by Barbara J. Burns, Ph.D. for CMS, June 2006.

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Fall 2006 NAMI Leadership Conference What We Know What We Do There Is a Great Divide Between… What We Know And What We Do

Well…what is AD/HD?: 

Well…what is AD/HD? A Biological Disorder AD/HD is one of the most researched areas in child and adolescent mental health. However, the precise cause of the disorder is still unknown.

 What do the Kids Say?: 

What do the Kids Say? “My head is just like a TV set-except it has no channel selector. I get all the programs on my screen at the same time.”

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“when I sit in class, I keep having ‘mind shifts’. I never know when my mind is gonna shift away so I lose what’s happening.”

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“I like to move around a lot. When I sit still, I get tired. I get bored. I need action.”

Coping with Common Challenges(A Baker’s Dozen): 

Coping with Common Challenges (A Baker’s Dozen) Disorganization Inattention Forgetfulness Impulsivity Impaired sense of time Sleep problems Messy handwriting

Coping with Common Challenges: 

Coping with Common Challenges Work slowly or rush through things Slow processing speed vs “careless” errors Difficulty with written expression Difficulty remembering facts and formulas Procrastination; difficulty getting started Difficulty controlling emotions Restlessness/hyperactivity

Defining Depression: 

Defining Depression Depression in children is characterized by a persistent sad mood; loss of interest or pleasure in activities that were once enjoyed; significant change in body weight or appetite; difficulty sleeping or oversleeping; physical slowing or agitation; loss of energy; feelings worthlessness or inappropriate guilt; difficulty thinking or concentrating; recurrent thoughts of death or suicide and, at times, suicidal tendencies. National Institute of Mental Health, 2005

Depression: Mood ChangesSigns and Symptoms: 

Depression: Mood Changes Signs and Symptoms Depressed mood Feelings of hopelessness Loss of interest/pleasure Irritable mood/anger Distractibility Excessive guilt/self-blame Negative thoughts Suicidal ideation Unrealistic negative self-worth-look for evidence of personal faults Increased worry or fear

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Key Points for Depression Depression can impact classroom and everyday functioning in many ways. Depression is a sleep and energy disorder. Depressive disorders in children are brain-based. There are many effective interventions that can be used at home and in the classroom.

Defining Dysthymia: 

Defining Dysthymia Dysthymia is a less severe yet typically more chronic version of depression and is diagnosed in children and adolescents when a depressed mood persists for at least one year and is accompanied by at least two other depressive symptoms. National Institute of Mental Health, 2005

Depression: Cognitive Changes Signs and Symptoms: 

Depression: Cognitive Changes Signs and Symptoms Difficulty concentrating Delayed mental reasoning Impaired ability to think Problems making decisions Slow movement, speech, and thinking Disinterest in normally pleasurable activities Forgetful

 Depression: Physical Changes Signs and Symptoms: 

Depression: Physical Changes Signs and Symptoms Changes in appetite (overeating and/or under eating) Sleeping problems (excessive or insomnia) Fatigue, lethargy (tired all the time) Slow reaction time Slow gait Psychomotor agitation abnormal activity level/ movement pacing hand wringing pulling/rubbing skin Small tasks require great effort and are exhausting Appears oppositional-work refusal

School-wide Interventions: 

School-wide Interventions

Classroom Interventions: 

Classroom Interventions

 Defining Bipolar Disorder : 

Defining Bipolar Disorder Bipolar Disorder - is characterized by episodes of major depression. as well as episodes of mania - periods of abnormally and persistently elevated mood or irritability accompanied by at least three of the following symptoms: overly-inflated self-esteem; decreased need for sleep; increased talkativeness; racing thoughts; distractibility; increased goal-directed activity or physical agitation; and excessive involvement in pleasurable activities that have a high potential for painful consequences. National Institute of Mental Health, 2005

Bipolar Disorder: 

Bipolar Disorder Mood/Cognitive Symptoms of Mania Abnormally elevated mood/irritability Hallucinations Delusions Grandiose statements about self Racing thoughts Inflated self-esteem

Bipolar Disorder: 

Bipolar Disorder Physical/Behavioral Symptoms of Mania Increased talkativeness Uncontrollable temper tantrums Abnormally active/hyperactive Excessive energy Pressured speech Excessive risk-taking/daredevil behavior Hyper-sexuality Atypical speech patterns Active much of the night/decreased need for sleep

School-wide Interventions: 

School-wide Interventions

Classroom Interventions: 

Classroom Interventions

The Full Effect of Anxiety: 

The Full Effect of Anxiety Interpersonal Relationships Performance Behaviors Dr. L. Read Sulik

Anxiety: Mood Changes Signs and Symptoms: 

Anxiety: Mood Changes Signs and Symptoms “Fight-or-flight” response “Freeze or shut down” Quick to anger Fearful/panicky Excessive worry Low tolerance for frustration Irritability Looks terrified Sadness Hypersensitivity/ feelings easily hurt

Anxiety: Cognitive Changes Signs and Symptoms: 

Anxiety: Cognitive Changes Signs and Symptoms Sluggish thinking/slow to participate Avoids or does not complete tasks Memory difficulty Difficulty concentrating Lack of confidence in skill and ability/gives up easily Automatic negative thinking Excessive worry about homework grades assignments tests

Anxiety: Physical ChangesSigns and Symptoms: 

Anxiety: Physical Changes Signs and Symptoms Chest pain, increased heart rate, chills, trembling, profuse sweating Shortness of breath Abdominal distress Hypersensitivity to environmental stimuli (e.g. lights, sound, touch, smells) Flat affect/appears detached Cries frequently Avoids group functions/isolates self Frequent absences Fatigue Nightmares, sleep disruption Dry mouth, dizziness, nausea, diarrhea Aggressive actions Obsessions and compulsions

School-wide Interventions: 

School-wide Interventions

Classroom Interventions: 

Classroom Interventions

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Parent Perspective When parents were encouraged to reflect back on their child's educational experience and try to determine the things that might have been missing but would have been helpful to their child, the following were generated: What might have helped... *empathy and understanding of child's disorder by all staff that worked with him/her *appropriate accommodations and modifications made on a daily basis or as needed *course requirements modified as needed/when needed alternative assignments when needed extended time-lines for work when needed homework waiver when needed *testing/project options *primary contact person-especially at secondary level *delayed start time if needed

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*part time flexible day as needed *homebound option when needed *realistic goals ("parents are worried about keeping the child alive...school is concerned about credits.") *outcome based vs completing ALL activities for "credit“ *empathy from peers

Help! : 

Help! Individuals can help! Service organizations can help! Libraries, recreational programs, kind and sensitive neighbors, extended family members, small business owners-anyone who has contact with children.

How Can We Help At School?: 

How Can We Help At School? Knowledge of mental illness in children and its impact on school performance and social interactions Understanding and empathy Acceptance No bullying polices and enforcement Flexibility Adjustable and realistic expectations based on where the child is now Personal attention Positive feedback and encouragement Recognize efforts Utilize school student services as needed Cooperation with treatment recommendations Parent communication

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Would You Ever Say… …to a student who has a visual impairment, “Look at the board! Can’t you see what it says?” …to a student who has a hearing impairment, “You weren’t listening, I just gave that direction!” …to a student with a physical disability, “Get up and get it yourself!” …to a child with a learning disability, “This is so easy, why don’t you understand this?” …to a child with AD/HD, “If you were paying attention, you would have heard my directions.” …to a child with severe depression, “Pull yourself together, things aren’t that bad.” Treating a child with a brain disorder like he/she is a behavior problem (punishing) is doing the same thing because we holding the individual personally responsible for having a chemical imbalance in their brain.

Bridging the Gap Between Science and Service : 

Fall 2006 NAMI Leadership Conference Bridging the Gap Between Science and Service

NO…buteducation will help!: 

NO…but education will help!

Resources: 

Resources Books Videos/DVD’s Web sites Parent Support Groups (CHADD) www.chadd.org Wisconsin Family Ties www,wifamilyties.org NAMI (National Alliance on Mental Illness) www.nami.org