Our Children: Early Identification of Mental Health Issues Ushimbra Buford, M.D.

Stop The Stigma: A Mental Health Summit

May 2, 2015

Framework

Stigma, as a barrier to mental heath care, is recognized and continues to be a major factor in identification and treatment

Various types of stigma exist and can create very different types of mental health outcomes

Individuals are affected by perceived discrimination, which leads to greater internalized stigma

Stigma is a global phenomenon with mental health services/training being severely underdeveloped in many developing countries

Other Factors

Ethnic differences with regard to trust of mental health providers

The detrimental effects of stigma is increased by poverty, cultural beliefs and previous experiences with the health care system

Media plays a huge part in the belief structure surrounding mental illness

Resulting Practices

Some parents feel a greater barrier to accessing mental health care secondary to socioeconomic and stigma-related issues

Internalized stigma can lead to lower self-esteem and higher symptom severity

People who could benefit the most are the less likely to seek out, or be exposed to, critical services

Culture of Honor

‘Honor’ states (U.S. south/west) have widespread stigma (self, family, institution)

Honor states in the US invest less in mental healthHave a lower ratio of mental health practitioners to

PCPsHave a lower percentage of state budget devoted to

mental health services

Early Identification

10-20% of children have a DSM mental illness 25-30% receive services that need them ¾ of all the cases present by age 24; ½ of all cases by age 14 9 years is the average time from 1st signs/symptoms and

receiving treatment (2 years for psychotic illness)

Early Identification/Barriers

Research suggests that at-risk children can be identified early

80,000 public schools in the U.S.; less than 10% have comprehensive mental health services

2-4x higher rates of mental illness in incarcerated youth vs. general population

Early Identification/Benefits

Can prevent high-risk problems like suicide, substance abuse, youth violence and accidents

The protective effects of mental health treatment include more positive self-appraisal, better societal integration, and better quality of life

Overall effectiveness, of mental health treatment, is greater for younger children than adolescents

At What Price?

Diverting one child from a negative outcome can save society ~2 million dollars over the lifetime

Prevention strategies

-Universal

-Selective

-Indicated

So What Happens?

1/3 of global burden of disease for adolescents is accounted for by mental illness

Mental health disorders are the leading cause of disability-adjusted life years (DALYs) from all non-communicable diseases

The burden of stigma raises significant barriers to pursuit of vocational, housing, personal and healthcare goals

Real World Limitations

Reduced access to mental health providers Shortage of mental health providers/insufficient

reimbursement- only 7,000 child psychiatrists in the US Difficulty in performing research because of participant

stigma and societal stigma

Maladaptive Behavior

As high as 70% of incarcerated youth have at least one DSM dx

1/3 of incarcerated males receive help who require it 1/4 of incarcerated females receive help who require it Untreated ADHD may increase the prevalence of psychiatric

disorders, substance use disorders, criminality and personality disorders

Unintended Consequences

Untreated mental illness leads to lower SES, lower quality of life, higher costs to society

Less engagement and utilization of medical/dental services

Increased provider frustration and decreased provider empathy

Solutions

Education of the public is, and should remain, a main component of the strategy

Decreasing institutional bias/separation between mental illness and medical illness

Media portrayals- more positive images, more realistic stories

Solutions

Strengthening protective factors High maternal & child self-esteem Good maternal emotional health Adequate social support, good academic performance,

adequate quality parenting

Solutions

Integrated health care system (school, clinic)- MCPAP model, headspace programs

TeleHealth for underserved areas Increasing funding for community-based

activities/resources

Thank You