Mental Health and Secondary Transition

Evidence-Based Treatments and Mental Health Issues for Young Adults:What They Need and What We Need to DoMaryann Davis, Ph.D.Research Associate ProfessorDirector: Transitions Research & Training CenterCenter for Mental Health Services ResearchDepartment of PsychiatryUniversity of Massachusetts Medical SchoolAcknowledgements

Major Collaborators:Charles Lidz, Ph.D., William Fisher, Ph.D., Lisa Mistler, MD., UMass Medical School, Center for Mental Health Services Research, Dept. of PsychiatryAshli J. Sheidow , Ph.D., Michael McCart, Ph.D., Scott Henggeler, Ph.D. Medical University of SC, Family Services Research Center, Dept of Psychiatry and Behavioral SciencesEdward Mulvey, Ph.D., Univ. of Pittsburgh Medical School, Dept of Psychiatry, Mary Evans, Ph.D., University of South Florida, Dept of Nursing and Public Health

Funding from NIMH (R01 MH067862-01A1, R34-MH081303-01, R34 MH081374-01, RC1MH088542-02), and NIDRR & SAMHSA (H133B090018), UMass Medical Schools Commonwealth Medicine

Visit us at: http://labs.umassmed.edu/TransitionsRTCThe content of this presentation does not necessarily reflect the views of the funding agencies, nor their endorsement

2OverviewWhy this age group needs specific Evidence Based Treatments/Practices (EBT/Ps)EBT/Ps in developmentShared features of EBT/PsSerious Mental Health Conditions (SMHC)Serious Emotional Disturbance OR Serious Mental Illness OR Psychiatric DisabilityMH diagnosis causes substantial functional impairment in family, social, peer, school, work, community functioning, or ADLsNot pervasive developmental disorders, substance use, LD, ID (these can co-occur) Transitions RRTCGore, FM., Bloem, PJN, Patton, GC, Ferguson, J, Joseph, V, Coffey, C, Sawyer, SM, & Mathers, CD (2011). Global burden of disease in young people aged 1024 years: a systematic analysis. Lancet, DOI:10.1016/S0140-6736(11)60512-6

15-19 Year olds20-24 Year oldsMalesMalesFemalesFemalesAmericasEuropeHigh IncomeWorldHIV, TB, malariaMaternal conditionsOther communicable diseasesOther non-communicable diseasesNeuropsychiatric disordersInjuriesMajor causes of disease burden in Disability Adjusted Life Years IN THE WORLDLeading Neuropsychiatric Disorders causing DALYs:Unipolar Depression* (7.9-9.9%)Schizophrenia (4.2-5.3%)Bipolar Disorder (4/1-5.1%)Within top 6 causes of DALYs in 15-24 yr olds in the worldOne of the reasons to focus on the MH needs of this age group is that MH and substance use disorders are the leading causes of disability in this age group5

Complete schooling & trainingContribute to/head householdBecome financially self-supporting

Be a good citizenObtain/maintain rewarding work

Develop a social network

Developmental Changes Underlie Abilities to Function More MaturelySupporting the Transition to Adulthood5/3/06Maryann Davis, Ph.D. for MA DMH6We tend to have these expectations based more on chronological than developmental age, particularly as our society relies increasingly on laws to dictate social policy.Critical Window of Development6 Paths to Adulthood (marriage, parenting, education, residence, employment at age 24)Fast starters (12%); high rates of marriage, parenting, school completion, home-ownership, employment for the futureParents without Careers (10%); living with spouse/partner, not working/poor jobs (71%)Educated Partners (19%); living w spouse/partner, no kids, higher education, career-step jobsOsgood, E.W., Ruth, G., Eccles, J.S., Jacobs, J.E., & Barber,, B.L (2005). Six paths to adulthood. In R.A. Settersten, F.F. Furstenberg, & R.G. Rumbaut (Eds.). On the Fontier of Adulthood: Theory, Research, and Public Policy. Univ. Chicago Press. Pp320-355. Critical Window of Development6 Paths to Adulthood contd (marriage, parenting, education, residence, employment)Educated Singles (37%); most college completion, living w parents, career-step jobs, no partner/kidsWorking Singles (7%); some college, living with parents (some own home), in job for future, no partner/kidsSlow Starters (14%); not well established in relationship, residence, employment or education, 25% w kids.Osgood, E.W., Ruth, G., Eccles, J.S., Jacobs, J.E., & Barber,, B.L (2005). Six paths to adulthood. In R.A. Settersten, F.F. Furstenberg, & R.G. Rumbaut (Eds.). On the Fontier of Adulthood: Theory, Research, and Public Policy. Univ. Chicago Press. Pp320-355. Valdes et al., 1990; Wagner et al., 1991; Wagner et al., 1992; Wagner et al., 1993; Kutash et al., 1995; Silver et al., 1992; Embry et al., 2000; Vander Stoep, 1992; Vander Stoep and Taub, 1994; Vander Stoep et al., 1994; Vander Stoep et al., 2000; Davis & Vander Stoep, 1997; Newman et al., 2009Youth with SMHC Struggle as Young AdultsFunctioning among 18-21 yr oldsSMHC in Public ServicesGeneral Population/without SMHCComplete High School23-65%81-93%Employed46-51%78-80%Homeless30%7%Pregnancy (in girls)38-50%14-17%Multiple Arrests by 25yrs44%21%9Individuals with MH disorders struggle in main areas of functioning relative to their peersFunctioning in Adults with Psychiatric Disorders; Young Adults Different from Mature Adults*2 (df=1)=31.4-105.4, p