By Laurie Flynn
7/1/2003 -- According to the Surgeon General's 2001 National Action Agenda for Children's Mental Health, the United States is experiencing a crisis in child and adolescent mental health.
One in 10 American children and adolescents suffer from a mental illness, which disrupts social, academic, and emotional functioning. Sadly, only 20 percent of them receive mental health services.
Suicide is also a significant problem for our youth. It is the third leading cause of death among teens, and according to a study done by the federal Substance Abuse and Mental Health Services Administration, millions more are at risk.
Ninety percent of youths who commit suicide suffer from depression or another diagnosable and treatable mental illness at the time of death. More than half were symptomatic for more than a year before their deaths, leaving plenty of time for intervention.
Adolescent depression came home to my family as an issue when my daughter made a suicide attempt in her senior year of high school. She had deteriorated inexplicably and rapidly, moving quickly from severe stress to depression.
Thankfully, she was successfully treated and went on to college and graduate school. Last month she was married. My family story has a happy ending, but thousands of parents and teens are not so fortunate. That's why I speak out everywhere urging mental health check-ups for youths.
In 2000, the Carmel Hill Center in the Columbia University Department of Child and Adolescent Psychiatry launched Positive Action for Teen Health (PATH), a national initiative to identify young people with untreated mental illness and prevent suicide in youth.
Working at the federal, state, and local levels, PATH is committed to raising awareness of the problems of adolescent suicide and untreated depression and to helping policymakers and communities implement effective solutions.
PATH has been endorsed by a variety of health and education organizations including the National Association of School Psychologists, American Academy of Child and Adolescent Psychiatry, and School Social Work Association of America.
The primary goal of PATH is to ensure that all youths are offered a mental health check-up before graduating from high school.
The Columbia University TeenScreen Program is one of several such programs working toward the goal of universal screening.
Research conducted on TeenScreen reveals it is extremely effective at identifying youth at risk for depression, suicide, and other mental disorders. It is currently being implemented at 69 sites in 27 states. We hope to add 400 more communities over the next several years.
The TeenScreen program works by creating partnerships with schools and communities to implement early-identification programs for suicide and mental illness.
Our staff works with interested groups to develop screening programs that are based on the TeenScreen model but also adapted to accommodate the specific needs and resources of each community.
Consultation, training, screening instruments, materials, and technical assistance are provided free of charge to qualifying schools.
The TeenScreen program uses a two-stage process to identify at-risk youths. First, all youths who have parental consent -- and who themselves assent to participate -- complete a 10-minute, self-administered questionnaire called the Diagnostic Interview Schedule for Children (DISC) Predictive Scales.
The questionnaire, known as DPS, screens for social phobia, generalized anxiety disorder, major depression, alcohol and drug abuse, and suicidal feelings. The DPS is not a diagnostic instrument, but it does indicate which students require further evaluation.
Teens who are negative on the DPS are dismissed from further screening. Teens who are positive are advanced to the second stage, where they are assessed by a mental health clinician to determine if further evaluation or treatment would be beneficial.
If professional services are recommended, the youth and his or her family are given assistance with the referral process.
Research conducted on the program revealed that it not only effectively identifies at-risk youths, but also that the majority of youths found to have mental health issues are not already receiving services and are not even known to have problems.
A study of approximately 2,000 high school students found that only 31 percent of students with depression, 26 percent of students who were contemplating suicide, and 50 percent of those who had made a suicide attempt were known to have problems or had raised any concern among school personnel.
This indicates that a majority of students who are suffering from a mental illness and are at risk for suicide are not being detected. These students can be found, however, through the implementation of a simple early-identification screening program.
With both schools and teenagers being placed under increasing pressure to achieve academically, we must ensure that our youths are being given the help and support they need. If teens are suffering with a crippling mental illness, how can they be expected to perform well in school?
Mental health screening and referral allows us to find teens who are dealing with a mental illness and refer them to treatment before their problems become so big that suicide seems the only way out.
Columbia University is committed to assisting as many communities as it can in establishing local screening programs. I hope you share my view that expanding mental health check-ups for youth is an urgent public health priority.
Laurie Flynn is national director of Positive Action for Teen Health and director of the Carmel Hill Center at Columbia University.