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By Darcy Gruttadaro, Director, NAMI Child and Adolescent Center
Two reports released in recent weeks provide updated views of mental health trends among children and youth.
On Nov. 13, 2013, JAMA Psychiatry published a study based on data from 1995-2010, titled "National Trends in the Mental Health Care of Children, Adolescents, and Adults by Office-Based Physicians."
The other report, "Psychotropic Medication Use Among Adolescents: United States, 2005–2010" appears in a National Center for Health Statistics (NCHS) data brief for December published by the U.S. Centers for Disease Control and Prevention (CDC).
The past several years have seen an increasing number of office visits by children and adolescents seeking mental health care. The JAMA Psychiatry data includes children and youth visiting psychiatrists, pediatricians and non-psychiatry practices. Researchers found that the number of office visits for mental health care rose faster for youth than for adults.
Given that only about half of children and youth living with mental illness receive care, the study authors see this data as progress in reducing the number of youth with untreated psychiatric disorders.
The majority of increased office visits occurred outside of psychiatric practices, showing a stepped up need for more effective collaboration between primary care and mental health care providers and families. The study also found an increase in the number of psychotropic medication prescriptions for youth during this same time period.
Increased office visits are an indicator of progress. However, given the high rate of care delivered in primary care settings, the study highlights the need for increased cross-training and effective collaboration between mental health and primary care providers.
It also shows the clear need to build safety and quality standards into mental health care delivered to children and youth in primary care practices, especially when it comes to the use of psychotropic medication.
NAMI has previously surveyed families with children with psychiatric disorders about their experiences in primary care. The results showed real opportunity to improve the knowledge and expertise of primary care providers. Based on the survey, NAMI created an online resource center on mental health and primary care. It includes the survey results.
The CDC/NCHS study shows that about 6 percent of youth ages 12 to 19 are being treated with psychotropic medication for a psychiatric disorder. The study authors concluded that 6 percent is what would be expected in medication use given the prevalence of psychiatric disorders in that age group.
Depression and attention deficit hyperactivity disorder (ADHD) are the most common mental health disorders in adolescents. The study found that approximately 3.2 percent of youth are taking anti-depressant medication and the same percentage of youth is taking ADHD medication.
Anti-depressant medication use among this age group dropped slightly from previous years. This may be because the Food and Drug Administration (FDA) in 2004 began requiring a black box warning on anti-depressant medication.
Not all youth with depression require medication, however the failure to use medication when it is needed can lead to an increased risk of suicide. NAMI has published a Family Guide -- What Families Need to Know about Adolescent Depression that includes discussion of treatment options.
The CDC/NCHS study also reported that males were more likely than females to use ADHD medication, while females were more likely than males to use anti-depressant medication.
Psychotropic medication use was higher among non-Hispanic white adolescents at more than 8 percent compared to 3.1 percent for non-Hispanic African-American youth and 2.9 percent Mexican-American adolescents. Several explanations may exist for the differences, with stigma and disparities in accessing mental health care likely contributing factors.
Finally, the study reported that about one-half of adolescents using psychotropic medication in the past month had seen a mental health professional in the past year, while 80 percent of adolescents taking two or more psychotropic medications had seen a mental health professional in the past year.
As discussed in NAMI’s Family Guide, psychiatric disorders in children and youth can be effectively treated in a number of ways— including medication or, psychotherapy or a combination of approaches. The key is for families to understand treatment options and the risks and benefits of any proposed treatment.
The more educated and informed that families and youth are about these issues; the better the outcomes are likely to be.