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Suicide Prevention and Youth: Saving Lives

Statement of Suzanne Vogel-Scibilia, M.D. NAMI National Board of Directors
Submitted to the Senate Health Education Labor and Pensions (HELP) & Subcommittee on Substance Abuse and Mental Health Services

Hearing Held on March 2, 2004

Chairman DeWine, Senator Kennedy and members of the Subcommittee, NAMI would first like to thank you for your leadership in holding this critically important hearing on Suicide Prevention and Youth: Saving Lives.

I am Suzanne Vogel-Scibilia, M.D. of Beaver, Pennsylvania, a member of the National Alliance for the Mentally Ill (NAMI) Board of Directors and a psychiatrist serving both youth and adults in my practice. In addition to serving on the NAMI Board, I am also the mother of five children. Two of my children are diagnosed with mental illnesses and one of my sons has attempted suicide – so I know first hand about this troubling issue, as do many other NAMI families.

I am pleased today to submit the following testimony on behalf of NAMI on the critically important issue of youth suicide and steps that must be taken to ensure early intervention and suicide prevention to reduce the tragically high number of youth suicides in our nation.

NAMI is a nonprofit, grassroots support and advocacy organization of consumers, families (including parents and caregivers of children and adolescents with mental illnesses) and friends of people with serious mental illnesses. Founded in 1979, NAMI today works to achieve equitable services and treatment for more than 15 million Americans living with mental illnesses and their families.

The Crisis in Youth Suicide and Untreated Mental Illnesses

Youth suicide is a public health crisis linked to underlying mental health concerns. According to the Surgeon General’s 1999 seminal report on mental health, 1 in 10 youth in the United States suffers from a mental illness severe enough to cause impairment. Yet, fewer than 1 in 5 of these young people receives needed mental health treatment.

Too many youth in our nation with mental health needs are not receiving any services. The circumstances are worse for African-American, Native-American, Latino and other youth from ethnically and culturally diverse communities – who often bear a greater burden from unmet mental health needs (Surgeon General 2001 Report on Mental Health: Culture, Race, and Ethnicity).

We know the staggering long-term consequences for the roughly 80% of youth with mental illnesses who fail to receive services. Suicide is the third leading cause of death in youth aged 10 to 24. (Centers for Disease Control, 1999) Over 4,000 young lives are lost each year to suicide. Studies show that 90% of youth who commit suicide were suffering from a diagnosable and treatable mental illness at the time of their death (Shaffer, 1996).

It is difficult to imagine the pain associated with losing a child to suicide. NAMI wishes to acknowledge the incredible courage that Senator Gordon Smith (R-OR) and his wife exhibited at the hearing by sharing their recent and unthinkable personal loss of their young son to suicide. Their willingness to speak about this tragedy – undoubtedly one of life’s most painful experiences -- and his struggle with mental illness helps to raise a much broader awareness about these issues.

NAMI also appreciates the tremendous work of the Suicide Prevention Action Network (SPAN) in raising awareness and educating the public and policymakers about suicide and the impact that it has on families and communities.

Suicide is not the only disastrous consequence of untreated mental illnesses in youth. They also tragically end up in the criminal justice system. According to a recent study – the largest ever undertaken – an alarming 65% of boys and 75% of girls in juvenile detention have at least one psychiatric diagnosis. (Teplin, Archives of General Psychiatry, Vol. 59, December 2002). The prevalence rates of children and adolescents with mental illnesses in the juvenile justice system is a moral outrage and speaks to our nation’s failure to build an effective mental health treatment system.

Youth with mental illnesses also have the poorest academic achievement and the highest failure and dropout rates of any disability group. We must respond to these crises with the necessary political will to change the broken mental health system in this country.

What is the impact of untreated and poorly treated mental illnesses in children on families? Simply put – devastating. Stigma and shame drive many families away from the treatment system. Suicide severely impacts the families left behind – who often wrongly live with extreme shame and guilt over not having prevented the death of their loved one.

More children and young adults die from suicide each year than from cancer, AIDS, heart disease, chronic lung disease, stroke, and birth defects combined. Our nation is experiencing a public health crisis related to mental illnesses in youth and suicide. The sad reality is that we know how to treat most mental illnesses in youth and many of these tragedies could be avoided.

What Can Be Done?

Our nation simply must make early identification of mental health needs in youth and appropriate intervention -- a national priority. The need to do so is now well documented in report after report.

Schools and primary care settings are a natural place to conduct early mental health screenings and to ensure appropriate interventions for children and adolescents and their families. These settings are familiar, comfortable and low-stigma places to reach children with mental health needs and their families.

NAMI applauds the work of Laurie Flynn, the national director of the Columbia University TeenScreen program and the long-time former Executive Director of NAMI. Her testimony outlined the vital need for mental health screening for youth and the need to refer young people, when indicated, for a more thorough mental health evaluation and services. The Columbia University TeenScreen program, recognized in President Bush’s New Freedom Commission on Mental Health Report, represents an effective program to detect mental health concerns in youth and to link them to appropriate services.

We also need to educate and train our nation’s school professionals about the early warning signs of mental illnesses. Families express grave concern that school professionals often do not understand even the basic facts about early onset mental illnesses. Consequently, they are not in a position to recognize the early warning signs of these disorders and to refer a student for an appropriate evaluation. Also, NAMI families report that school officials continue to blame parents for a child’s mental illness – which often drives youth and families away from the treatment system.

It is also critically important that we identify youth with mental health needs and intervene with appropriate services in other child-serving systems, including – juvenile justice, substance abuse programs, the child welfare system and others. Unfortunately, most families express grave concern that these systems fail to communicate and fail to coordinate services. The children’s mental health system and other child-serving systems are fragmented and overly bureaucratic. Most states and communities fail to offer home- and community-based mental health services. Families in crisis are left on their own to navigate multiple, complex systems that do not work well. This often results in youth falling through the cracks. It is vital that states and child-serving systems develop effective interagency collaboration to help identify youth at risk for suicide and in need of mental health services and offer home- and community-based mental health services.

NAMI is frequently contacted by families from across the country that have struggled to get treatment for their child’s mental illness. Often these families have long since exhausted their private insurance benefits for mental health coverage (90% of private health insurance plans place restrictive and discriminatory caps on mental health benefits) and paying for intensive services is simply not financially feasible. Most of these families do not qualify for Medicaid benefits. State agencies and others tell many families that the only way to access critically needed treatment is by relinquishing custody of their child to the state. This causes unthinkable stress for children and families, hit at their most vulnerable moment.

One of the key barriers to treatment is the severe shortage of available specialists trained in the identification, diagnosis and treatment of childhood mental illnesses. Primary care providers report seeing a large number of children and youth with mental health problems, but have difficulty finding available clinicians to take referrals. The Surgeon General’s 1999 report found that "there is a dearth of child psychiatrists, appropriately trained clinical child psychologists, or social workers." Our nation currently has approximately 6,300 child and adolescent psychiatrists with a need of 32,000 to treat young people with mental disorders. Families are put on long waiting lists for mental health services. We must address this critical shortage of qualified children’s mental health providers.

Stigma drives youth and families away from the mental health treatment system. Families are suffering a great and unnecessary burden because of the lack of effective treatment for youth with mental illnesses. The broken mental health system all too often leads to tragic consequences – including youth suicide .

Immediate Federal Action is Needed to Help Reduce Youth Suicide

NAMI applauds Senator DeWine and Senator Dodd for introducing federal legislation – The Youth Suicide Early Intervention and Prevention Expansion Act of 2004 – to help address the youth suicide crisis in our nation.

This legislation provides states, local governments and other eligible entities with funding to develop and implement effective statewide youth suicide early intervention and prevention strategies. This legislation holds real promise in helping to reduce youth suicide.

Clearly, though, other steps must be taken to address the youth suicide crisis and the unacceptably high percentage of youth with untreated mental illnesses. In addition to support for the Youth Suicide Early Intervention and Prevention Expansion Act of 2004 -- NAMI asks for Congressional support of the following federal legislation pending in Congress that can make a difference in reducing youth suicides in our nation –

  • The Paul Wellstone Mental Health Equitable Treatment Act of 2003 (S. 486 and H.R. 953) – parity legislation to end insurance discrimination in health insurance against children and adults with mental illnesses so that families can access appropriate mental health services for their loved ones (NAMI applauds Senators DeWine, Kennedy, Bingaman and Reed for cosponsoring this legislation);
  • The Keeping Families Together Act (S. 1704/H.R. 3243) – provides grants to states to develop home- and community-based mental health services to serve youth with mental illnesses and their families in the least restrictive and most appropriate setting and requiring child-serving agencies to collaborate in developing an appropriate service system (NAMI applauds Senator Bingaman for co-sponsoring this legislation);
  • The Family Opportunity Act of 2003 (S. 622) – allows states the option of expanding Medicaid coverage to low and middle-income families on a sliding cost-sharing basis for those families that have children with the most intensive mental health service needs (NAMI applauds Senators Enzi, Ensign, Kennedy, Bingaman and Reed for cosponsoring this legislation);
  • The Child Healthcare Crisis Relief Act (S. 1223 and H.R. 1359) – to address the national shortage of children’s mental health specialists which acts as a barrier to families accessing timely and appropriate services for their child (NAMI applauds Senator Bingaman as the sponsor of this legislation and Senator Kennedy for cosponsoring the bill).

Conclusion

Chairman DeWine and Senator Kennedy, thank you for the opportunity to share NAMI's views on this important issue. We look forward to working with you and all members of the HELP Committee to ensure that the Senate acts on the Youth Suicide Early Intervention and Prevention Expansion Act of 2004 to reduce youth suicide in this country.


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