Note to Mentally Ill Teens: You’re On Your Own

Treatment rates are woefully low for kids with psychological problems, a new study finds

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It’s a good thing for teenagers they’re as young as they are, otherwise we’d call them crazy. You don’t get to be volatile, moody, demanding and narcissistic, sleep all day, stay up all night and fall in love every 25 minutes without earning yourself a psychiatric diagnosis or two. But for the middle school and high school crowd, that’s just part of the job description.

Still,  mental illnesses are very real things and in kids and teens they’re often worse, because the soft clay of a still-developing mind may forever carry the marks of the traumas it endures. That’s why it’s especially important that teens who do suffer from psychological ills get the help they need early. According to a new study published in the online journal Psychiatric Services, however, mental illness in U.S. teenagers is going woefully undertreated—indeed, in numbers we’d never begin to tolerate if the same kids were suffering from physical sicknesses.

The research, conducted by epidemiologists Ronald Kessler of Harvard University and E. Jane Costello of Duke University, relied on National Institutes of Health interviews with 10,148 teenagers from ages 13 to 17. Studies that seek to determine the share of people with specific mental disorders who are receiving treatment can be tricky, because the mere act of being diagnosed typically means you’ve been to a doctor, and in most cases your care begins right there. Off the bat, you’re close to a 100% treatment rate.

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This study—like others of its kind—got around that by approaching families, requesting permission to interview kids and then asking them questions designed to tease out signs of various conditions. It’s not a perfect diagnose in a clinical setting, but it’s pretty good.

“There’s a long tradition in psychological epidemiology of doing this,” says Costello. “It gets you as close as possible to getting a sense of any possible disorders.”

The investigators looked for a broad range of conditions common among kids, including mood disorders, behavioral disorders and anxiety disorders. They found plenty of cases of them—but treatment was another matter. According to Kessler’s and Costello’s analysis, a teenager suffering from one psychological disorder has just a 32% chance of having received any treatment at all in the past year. For two disorders, the figure climbs to 44% and only for three or more does it cross the 50-50 mark, topping out at 69%.

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“The sicker the kids are, the likelier they are to have gotten treatment,” says Costello. But even then, was it the right kind? For the purposes of the study, “treatment” could mean as little as a single visit, and that visit didn’t even have to be with a psychologist or psychiatrist. School guidance counselors, social services case managers and even representatives of the juvenile justice system could count too.

“The proportion who actually saw a mental health professional was much lower,” says Costello, “at just 12.5% for one disorder, 20.6% for two, and 42.7% for three.”

If not all kids are treated equally, not all disorders are either. The conditions most likely to get the attention of some kind of caregiver were ADHD, oppositional-defiant disorder and any of the conduct disorders—precisely the problems which, coincidentally or not, were the likeliest to cause parents and teachers headaches. In 70% of cases, kids with those conditions got at least some kind of care. Other ills, such as panic disorders, social phobias and more-generalized anxiety disorders, from which kids often suffer silently, received less attention, with only 41.4% of kids seeing any kind of professional and only 22.3% seeing a psychiatrist or psychologist. For major depressive disorder, the numbers were a little better—62% for any care at all and 37% for a mental health professional.

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Numbers like this are sometimes shrugged off or simply denied away, since many teenagers—so the argument goes—may simply age out of their conditions. But that doesn’t really happen, or at least not the way the skeptics think. “People may not have the same psychiatric conditions in adulthood that they had as kids,” says Costello, “but they certainly move into adulthood with significant handicaps or vulnerabilities they wouldn’t otherwise have.”

What concerns Costello most is that hers and Kessler’s study is news at all, since treatment rates and the long- term result of kids doing without should be part of psychology’s foundational data. But years-long, longitudinal studies are by definition time-consuming and expensive, and there’s often neither the money nor the institutional bandwidth to conduct them. “In the U.S.,” Costello says, “getting funding for longitudinal studies is extremely difficult. People prefer short, sharp lab studies.”

The hard truth is, however, that those longitudinal studies are being conducted every day—with every undiagnosed, untreated child who grows through the teen years and into adulthood serving as an unwilling lab specimen. Better we should watch them—and help them—now, while we can still make a difference in the people they’ll become.

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