Mental Health and Suicide

CA Strategic Plan

Recommendations

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Youth Involvement
& Development

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Service Coordination

Families

Communities

Schools

Data

Outcome Areas

Injury Prevention

Mental Health and Suicide

Nutrition & Physical Activity

Alcohol, Tobacco
& Other Drugs

Teen Pregnancy & STI’s

Oral Health

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& Occupational Health

Out of Home Youth –
Resources on Mental Health

Mental Health and Suicide | Overview

Mental health and suicide

This is Chapter 3, Outcome Area 2 of California's adolescent health strategic plan. To view the full plan, click here.

Adolescence is an important time to prevent, detect, and treat mental health issues as many mental illnesses often appear for the first time during the teenage years. For example, an estimated 8% to 12% of adolescents suffer from depression, compared to only 2% to 3% of children.^84,85 Many teens and adults may not recognize symptoms of mental illness that should be a cause for concern because normal adolescent development entails tremendous cognitive, behavioral, and emotional changes. Research has shown that unrecognized or untreated mental and emotional health disorders increase young people’s risk of school failure and dropout, alcohol and drug use, HIV transmission, somatic ailments, and an array of other difficulties.³⁹ In a recent survey, 70% of California parents stated that they were somewhat to very worried about depression, suicide or mental health disorders among youth who live in their community.³⁹

Data snapshot

Mental Health

Mental illness is the most common cause of hospitalization for persons between the ages of 10 and 24, with the exception of childbirth, and is the second leading cause of disability for young adults.⁷⁵ Estimates of the prevalence of mental health disorders among youth vary depending on the definitions used and the age group studied.

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The Center for Mental Health Services within the U.S. Department of Health and Human Services reports that approximately 20% of youth ages 9 to 17 have some “diagnosable disorder,” and 9% to 13% are afflicted with a “serious emotional disturbance, with substantial functional impairment.”⁸
The Census Bureau reports that 5% of all school age youth suffer from severe emotional disability.¹¹
The 1992 California Mental Health Survey conducted by the California Department of Mental Health indicates serious mental health disorders in 5% to 7% of youth 0 to 17 years old, a range of 460,000 to 644,000 children and youth.¹¹

Table 3.1

The most common types of mental health issues among youth are listed in Table 3.1. Other common disorders include eating disorders (e.g., anorexia nervosa), learning and communication disorders, schizophrenia, and tic disorders (Tourette’s disorder). Risk factors for mental health disorders include: physical problems, intellectual disabilities, family history of mental and addictive disorders, and sexual orientation. For example, one analysis reports that 20% to 25% of all gay/lesbian/bisexual youth make a suicide attempt, while over 50% consider it seriously, and upwards of 30% of all youth suicides may involve lesbian and gay youth.²⁶

The consequences of mental health disorders are serious for both youth and society. National data indicate that 20% of students with serious emotional disorders are arrested at least once before leaving high school; 50% drop out of high school; and almost 75% of those who drop out are arrested within five years of leaving school.^86,87 Among youth entering juvenile corrections facilities, 73% have mental health disorders, and 57% have had prior mental health treatment or hospitalization.⁸⁸

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There is a lack of mental health services for youth. An estimated two-thirds of all young people are not getting the mental health treatment they need.^87,84 Publicly-funded county mental health programs reach only 2% of the 13 to 17 year old population.⁸⁹ When youth do receive care, the services they receive are often inappropriate.⁸⁵ Mental health services are too often crisis-driven, leaving many youth without timely preventive care. A recent survey of youth service providers conducted by the California Children Youth and Family Coalition found that 89% indicated that there was inadequate funding of preventive services in schools and other community-based settings. Approximately 86% felt that adults lack knowledge of how to help teens access needed mental health services, and 84% indicated that adults who interact with teens on a daily basis fail to recognize their mental health needs. Within California schools, there are too few mental health clinicians to address a growing need for psychological services in response to social changes such as decreased family stability, school and community violence, and teen suicide. California’s Education Code does not mandate a minimum ratio of school psychologists to students.

There is a dearth of research on children and adolescent mental health, especially in the area of medications for youth with mental health disorders.

Suicide

Figure 3.5

Figure 3.6

Figure 3.7

Suicide rates increase dramatically as teens move from early to middle adolescence (Figure 3.5). Trends in youth suicide rates show a slight decline since the mid-1980’s especially among young adults 20 to 24 in California (Figure 3.6). Suicide is a complex behavior usually caused by a combination of factors. According to the National Institute of Mental Health, a history of depression, alcohol or other drug use, and aggressive or disruptive behaviors are the strongest risk factors for attempted suicide in youth.⁹⁰ Other risk factors for suicide include adverse life events, family violence, family history of suicide, prior suicide attempt, firearm in the home, incarceration, and exposure to the suicidal behavior of others, including family, peers, or in the news or fictional stories. Over 64% of youth suicides nationwide involve firearms.⁹¹

There are significant gender disparities in suicide rates, with males having much higher rates during adolescence and throughout life (Figure 3.5). Although there are more completed suicides among males, suicide attempts are much more common among females—12% within the previous year as compared to 5% for males (Figure 3.7).⁷³ Males are more likely to use lethal methods such as guns or hanging, whereas females are more likely to try methods such as poisoning and overdosing. There are also ethnic disparities in suicide rates. In California, 1998 suicide rates per 100,000 in the 15 to 24 age group were: white 10.4, Hispanic 7.2, Asian 5.6, and African American 7.7.⁷² Although the population of Native American youth in California is too small to establish a reliable rate for the state, the national suicide rate of Native American youth is twice that of whites.

Examples of current efforts

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Medi-Cal is a major source of public funding for mental health and related support services. Medi-Cal also supports the federal Early and Periodic Screening Diagnosis and Treatment (EPSDT) program, known as the Child Health and Disability Prevention (CHDP) program in California. EPSDT requirements are designed to promote delivery of health care services which address the developmental and mental health needs of children and youth.
The California Department of Mental Health’s Children’s System of Care model (CSOC) is administered by counties to improve services for seriously emotionally disturbed children and youth served by more than one public agency. CSOC brings together various child-serving agencies and systems to collaboratively provide special education, child welfare, health, and juvenile justice services that address the needs of youth within the least restrictive environment possible.
The federal Individuals with Disabilities Education Act (IDEA) provides funding for school psychologists. With the goal of promoting safety and violence prevention, AB 166, which passed in 1999, provides funding for additional school psy-chologists and counselors. It also establishes an in-service training program for school staff to learn to identify at-risk pupils, to communicate effectively with them, and to make referrals to appropriate counseling.
Although not specifically focused on mental health, California’s Healthy Start Initiative, administered by the California Department of Education, enables schools to hire direct service staff or a coordinator who establishes linkages with community-based service providers. Many of these programs address student and family mental health needs.
The UCLA School Mental Health Project (SMHP) was created in 1986 to address mental health and psychosocial concerns through school-based interventions. The SMHP has established the UCLA Center for Mental Health in Schools, one of two national training and technical assistance centers funded by the federal Maternal and Child Health Bureau. The UCLA center approaches mental health and psychosocial concerns from the broad perspective of addressing barriers to learning and promoting healthy development. Specific attention is given to reducing fragmentation and enhancing collaboration between school and community programs.

Strategies to improve mental health and reduce youth suicide

1. Increase and improve mental health services for youth.

Increase state funding to expand the availability of mental health services for youth including case management, client support services, and brief interventions.
Improve compensation levels for community-based mental health providers.
Establish coordinated systems of care in all counties which address the mental health needs of youth, and open community mental health services to all youth regardless of insurance status.
Expand Medi-Cal for youth through age 21 to strengthen transitional mental health services and ensure continuity of care.
Eliminate barriers in public and private insurance programs to the provision of quality mental health and substance abuse treatment, and create incentives to treat patients with coexisting mental and substance abuse disorders.
Use EPSDT resources to fund a mental health assessment process for children and youth served by the public mental health, child welfare, and juvenile probation systems.

2. Expand outreach, screening and support for mental health disorders.

Expand community awareness of, and resources for, youth-focused suicide prevention and for mental health and substance abuse assessment and treatment. Train youth, professionals, and community members (e.g., clergy, teachers, coaches, correctional workers, and social workers) to recognize youth suicide risk and mental health disorders and to connect youth with services and supports.
Help families recognize and deal with mental health issues (e.g., psychosocial support, counseling, support groups, and respite care).
Increase funding for preventive services and expand care for youth with mental health disorders prior to crisis events.
Increase the use of schools, school-based health centers, workplaces, primary care, and family-planning services as access and referral points for mental health services.
Develop and implement programs for adolescents and young adults that emphasize peer support, peer relationships, and competency in social skills.
Expand crisis centers and hotlines. Train volunteers and paid staff to provide telephone counseling, “drop-in” crises services, and referral to mental health services.
Develop and implement strategies to reduce the stigma associated with mental illness, substance abuse, suicidal behavior and with seeking help for such problems.

3. Improve research on youth suicide prevention and mental health.

Increase research in the area of adolescent mental health on topics such as risk and protective factors related to suicide, effective suicide prevention programs, clinical treatments for suicidal individuals, and youth specific interventions.
Develop additional strategies for evaluating suicide prevention interventions and ensure that evaluation components are included in all suicide prevention programs.
Establish mechanisms for state- and local-interagency public health collaboration to improve monitoring systems for suicide and suicidal behaviors. Develop and promote standard terminology in these systems.

4. Decrease access to firearms.

Create and enforce weapons laws that will further reduce availability of weapons to youth and increase criminal penalties for selling or transferring a gun to a juvenile.
Limit or tax the sale of ammunitions.
Trace the origin of guns used in youth crimes to identify Source of illegal weapons.
Require safety features on firearms (e.g., magazine disconnect safety, trigger resistance, passing the “drop test,” manual safeties, and child safety locks).

Additional resources

Surgeon General’s Call to Action to Prevent Suicide. Department of Health and Human Services, U.S. Public Health Service, 1999.

Mental Health: A Report of the Surgeon General. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.

The Children’s Budget 1999-2000. Chapter 5: Children With Special Health Care Needs. Fellmeth, R.C. Children’s Advocacy Institute. www.acusd.edu/childrensissues, January 2000.

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