If you have a teenager in your life, or simply recall your own adolescence, you know it’s an emotionally treacherous time under the best of circumstances. But for millions of pre-teens and teens in the U.S., the adolescent years bring problems that go beyond the expected angst of growing up. About 20 percent of kids ages 13 to 18 have a behavioral health disorder, a category that includes mental illness, substance use, and eating disorders. In fact, half of all lifetime cases of mental disorders begin by age 14. Left untreated, mental illness can lead to poor school performance, substance abuse, and risky sexual behaviors, as well as stress within the family of the sufferer. It can also have serious long-term consequences if the teenager drops out of school or ends up in the juvenile justice system.
But as is the case with adults, not all teenagers who need help with their mental health get it—even if their condition is serious. In one survey of almost 6,500 American adolescents ages 13 to 18, for example, researchers found that about half of those with a mental disorder that caused them severe distress or impairment had never received treatment for their symptoms. (The study included mood disorders such as depression, anxiety disorders, ADHD, behavioral disorders, substance use disorders, and eating disorders.)
Barriers to treatment
Why do so few adolescents receive the mental health care that they need? The barriers are many and include the following:
Lack of access. There simply are not enough trained children’s mental health professionals to handle the number of children and adolescents with mental illness. According to 2012 data cited in a report by the American Academy of Child & Adolescent Psychiatry, the national average is a mere 13 child or adolescent psychiatrists per 100,000 children. In rural or economically disadvantaged areas, the rate drops as low as five doctors per 100,000 children. This means that pediatricians often have a difficult time referring their patients to qualified mental health professionals. The average wait time for an appointment for child or adolescent psychiatric care is close to two months, according to a survey by the Children’s Hospital Association, more than three times the benchmark wait time of two weeks for children’s hospital services.
This widespread lack of access has far-reaching consequences. Teens and families suffer longer, negative behavior patterns continue unchecked, and if mental illness is involved, the disease progresses.
Rising Rates of Teenage Suicide
A disturbing new report from the CDC shows that rates of adolescent suicide have risen substantially in the US in the last 15 years, especially among girls ages 10 to 14.
Insurance challenges. Even if there are qualified providers available, the cost of the service may be prohibitive. Many psychiatrists and therapists choose not to accept insurance, because their rate of reimbursement by insurance companies is often meager, especially for talk therapy. Families must pay out-of-pocket for services in those cases, which can become an unsustainable financial burden. (If your plan covers out-of-network providers, you may be able to get reimbursed some of the cost; check with your plan. Either way, you’ll still have to pay the full cost up front, which may be prohibitive for many people.)
Even with a qualified provider who takes insurance, financial issues remain. Treatment may require more than one visit per week, and the co-pays add up. And many insurance companies set a limit on how many visits they’ll pay for in a year before requiring a “review” to determine if additional treatment is medically necessary. In addition, patients and providers have alleged that even subtle differences in the way mental health claims are processed (such as increased “utilization reviews”) makes access to mental health care more difficult than access to medical or surgical care.
While there are federal and state mental health parity laws that are intended to require most insurance companies to provide mental health benefits in the same way they cover medical or surgical ones (for instance, not charging higher copays for mental health than medical services), these laws are not always effective or adequately enforced, according to a 2015 policy brief in the journal Health Affairs.
Social and culture stigma. Although it has decreased, there remains a stigma surrounding mental illness. Parents may have a perception that mental illness reflects poorly on them as parents, or that a behavioral health disorder will label a child as “troubled” or “bad,” leading to disparate treatment in school.
Adolescents may be hesitant to admit feelings of depression or anxiety and may not realize that mental illness is a real illness. They may be quick to blame themselves for feeling blue or socially isolated.In addition, parents and adolescents may not recognize the signs of mental illness and may chalk up persistent sadness, moodiness, or changes in sleep behavior to “being a teenager.” This may lead to missed opportunities, on the part of parents and school officials, to address and prevent mental illness.
Social stigma also prevents individuals who are often most in need of mental health care from getting it. For instance, people who identify as lesbian, gay, bisexual, or transgender (LGBT) often experience significant discrimination and violence, which can lead to psychiatric disorders, substance abuse, and suicide. In a 2011 report from the National Transgender Discrimination Survey, 41 percent of transgender individuals reported attempting suicide at some point in their lives. Unfortunately, many LGBT adolescents do not obtain needed mental health care; in many cases this is due to a lack of culturally competent providers.
Homeless adolescents are also at higher risk for untreated mental illness, with an estimated 50 percent of homeless youth thought to have serious mental illness or substance abuse disorders. Many of these teens do not obtain health care services, due not only to financial barriers, but also due to lack of familiarity navigating the health care system and distrust of social services and other agencies.
How to help a teen in need
Recognizing the signs and symptoms of mental illness in teens is a critical step toward getting appropriate treatment. Parents and adults who regularly work with teenagers, such as teachers and coaches, should be aware that sadness is not necessarily the most common symptom of symptom of depression in adolescents. If a teen suddenly complains of low energy, increased irritability, poor concentration, and even physical symptoms such as headaches and stomachaches, depression may be the cause.
If you suspect your child is suffering from a mental health problem, talk to your family physician about available mental health resources. Openly addressing mental and behavioral health problems can help decrease the social stigma surrounding them. Be aware of your rights to mental health treatment under federal mental health parity laws and those of your state. If you think you are being unlawfully denied mental health benefits, contact your state health insurance regulator to file a complaint.
Mental illness is real and can be treated. If you or a loved one are experiencing suicidal thoughts, call the 24 hour/7 day per week National Suicide Prevention Lifeline at 1-800-273-(TALK) 8255. If you believe a teen or anyone else is in immediate danger of harming him/herself or another person, call 911.
For more on what parents can do to help younger teens avoid or overcome depression and anxiety, see this excellent Q&A interview with Berkeley neuroscientist Ron Dahl by our friends at the Greater Good Science Center.
Published May 25, 2016