Objective C: Provide adequate and effective prevention and early identification for children and youth with mental and emotional disorders.
Mental illness/emotional disorders affect one in every five young people at any given time. To reduce the risk for developing disabilities, all of these children and youth should be identified and receive the help they need to develop normally. Early treatment works to minimize development of disabilities. Left untreated, childhood mental illness leads to chronic disabilities. Children and youth with emotional disorders are over represented in the juvenile justice system, substance abuse programs, school drop outs, teen pregnancy and suicide rates.
The Children and Youth Action Team urges that Alaska's mental health service system give higher priority to prevention, accurate diagnosis and early treatment interventions.
Prevention: Not all causes of mental health problems in children and youth are known. Both environment and biology are often involved. Biological causes include chemical imbalances, genetics, and damage to the central nervous system. These are considered to be neurobiological brain disorders, according to the medical community. To address these factors, the National Institute of Medicine gives the following recommendations which include the universal prevention steps: prenatal care, immunizations, head protection, and protection of young children from heavy metals. For some of these disorders, there is no known prevention.
Environmental factors placing children and youth at risk for mental health problems include: experiencing violence, abuse, neglect; loss of loved ones through death, divorce, or broken relationships; and such physical risks as lead poisoning and brain traumas. Social rejection as a result of race, sexual orientation, poverty or physical appearance or behavior also potentially influence the risk of mental health problems for youth. Undiagnosed and untreated learning disabilities are also a risk factor for emotional disorders in children and youth.
Additionally, according to the Casey Family Program, "it is estimated that up to 80% of children's distress is related to the combination of substance abuse, child abuse, and/or mental illness in the family." Prevention, therefore, must actively address family issues that increase risk factors for children.
Early identification/intervention: According to the national Center for Mental Health Services, 25% of children and youth have a diagnosable mental illness. And, at least 20% of these children and youth have a serious emotional disturbance that disrupts his or her ability to function. Without intervention, these disorders can lead to school failure, alcohol and other drug abuse, family discord, violence, or suicide. Suicide is a particularly critical issue for Alaska's youth. According to 1994 vital statistics data for the State of Alaska, the suicide rate in this state for 15 to 19 year old youth is 41.3 per 100,000, almost four times the national average.
Data suggests that one in five school age children have developed such serious disabilities that they qualify as "seriously emotionally disturbed" by national standards. Even higher rates are experienced among children ages 9 to 17. In 1992, a study by Dr. Norm Dingus for the Division of Mental Health and Developmental Disabilities estimated that two-thirds of Alaskan school children with a serious emotional disorder are not receiving help. Diagnosis of children is complex, due to developmental and other factors. When children receive inaccurate diagnoses, they receive inappropriate services that are costly and ineffective. Treatment delays may result in permanent disabilities.
Mental illness in children encompasses the full range of emotional and behavioral conditions affecting adults. Left untreated, the child may develop poor patterns of behavior and responses to family, teachers, and other children. Because of the lack of normal experience and the long time available to develop maladaptive behavior, childhood onset of mental illness may lead to more severe disabilities than adult onset disorders.
Children must have access to screening and diagnosis of mental health issues that include comprehensive medical, family, social, and psychological assessments, including strengths and impact on all life domains. Currently, evaluations are often uni-dimensional and more oriented to admitting or denying admissions to a particular program. There should be a screening process that identifies children who need medical and neurological assessments.
Fortunately, children's disorders may be more malleable than adult conditions because of the potential to intervene earlier in the development of the disorder. Hence, early identification programs are urged to prevent substance abuse and mental/emotional disorders and to reduce the huge human, economic, and social costs of these disorders. Mental illness should be identified as early as possible, and those whose onset are in early childhood should receive appropriate treatment. Early identification programs need to include teachers and parents. Diagnosis and treatment planning needs to be done by professionals trained in childhood mental and emotional disorders. Accurate diagnosis and early treatment can reduce the severity of illness. For example, early treatment of manic depression, an illness with frequent adolescent onset, has long been recommended because of the "kindling effect;" each episode causes physical changes in the brain that makes future episodes more likely and severe.
Early intervention is cost-effective. Research clearly shows that early intervention increases the developmental and educational gains for the child, improves the functioning of the family, and reaps long-term benefits for society. In addition, a recent federal study showed a high correlation among adolescent girls with mood disorders and teen pregnancy. Children whose family lives are disrupted by substance abuse or have been victims of emotional, physical or sexual abuse are at high risk for emotional disorders, suicide, teen pregnancy and substance abuse.
85. The Alaska Mental Health Board will work in conjunction with a Department of Health and Social Services working group to identify mental disorder prevention opportunities and define a plan for increasing current efforts.
86. The Alaska Mental Health Board will work in conjunction with a Department of Health and Social Services working group on early identification and intervention opportunities and develop a plan for increasing current efforts.
Responsible party (actions 1-2): Alaska Mental Health Board, Department of Health and Social Services
87. Parents and teachers should receive training in the use of tested screening tools that can identify children and youth who need referral to mental health professionals trained in diagnosis and treatment of childhood mental and emotional disorders.
88. The Department of Education will provide school districts with information about mental disorder screening tools and information about common disorders and their symptoms.
89. The Department of Education and children's advocates will encourage early diagnosis by multiple disciplines and early remediation of learning disabilities.
Responsible party (actions 3-5): Department of Education
90. Explore the potential for screening and assessment and referral conducted by the Division of Public Health in regional diagnostic clinics.
91. Expand Healthy Families, Headstart, and similar programs which offer proven in-home programs which can prevent early childhood emotional disorders.
92. Explore expansion of the Infant Learning Program to include children at risk of mental and emotional disorders.
93. Fully utilize Early Periodic Screening Diagnosis and Treatment and Child Find to identify emotional and behavioral disorders and refer them for appropriate treatment.
Responsible party (actions 6-9): Division of Public Health
94. The All Alaska Pediatric Partnership and others will be enlisted to provide training to private acute care medical practitioners in early identification and referral for childhood emotional disorders.
Responsible party: All Alaska Pediatric Partnership