Facts on Children’s Mental Health in America
The reports by the U.S. Surgeon General and the New Freedom Commission on Mental Health offer great hope to the millions of children and adolescents living with mental illness and their families. Through appropriate identification, evaluation, and treatment, children and adolescents living with mental illness can lead productive lives. They can achieve success in school, in work and in family life. Nonetheless, the overwhelming majority of children with mental disorders fail to be identified, lack access to treatment or supports and thus have a lower quality of life. Stigma persists and millions of young people in this country are left behind.
- Four million children and adolescents in this country suffer from a serious mental disorder that causes significant functional impairments at home, at school and with peers. Of children ages 9 to 17, 21 percent have a diagnosable mental or addictive disorder that causes at least minimal impairment.
- Half of all lifetime cases of mental disorders begin by age . Despite effective treatments, there are long delays, sometimes decades, between the first onset of symptoms and when people seek and receive treatment. An untreated mental disorder can lead to a more severe, more difficult to treat illness and to the development of co-occurring mental illnesses.
- In any given year, only 20 percent of children with mental disorders are identified and receive mental health services.
Anxiety disorders were the most common condition (31.9%), followed by behavior disorders (19.1%), mood disorders (14.3%), and substance use disorders (11.4%), with approximately 40% of those with one class of disorder also meeting criteria for another class of lifetime disorder. The overall prevalence of disorders with severe impairment and/or distress was 22.2%; (11.2% with mood disorders; 8.3% with anxiety disorders; 9.6% behavior disorders). The median age of onset for disorder classes was earliest for anxiety (6 years), followed by 11 years for behavior, 13 years for mood, and 15 years for substance use disorders.
These findings provide the first prevalence data on a broad range of mental disorders in a nationally representative sample of U.S. adolescents. Approximately one in every 4–5 youth in the U.S. meets criteria for a mental disorder with severe impairment across their lifetime. The likelihood that common mental disorders in adults first emerge in childhood and adolescence highlights the need for a transition from the common focus on treatment of U.S. youth to that of prevention and early intervention.
The Surgeon General estimates that 6.5 million emotionally disturbed and 3.5 million severely disturbed children are not getting the help they need (U.S. Public Health Service, 2000).
Few families in the United States are untouched by mental illness. According to current estimates, at least one in five people has a diagnosable mental disorder during the course of a year. This includes adults as well as children. The prevalence of mental health disorders is defined as the number of people with a disorder that are present in the general population. This is usually expressed as a certain number per thousand people or a percentage.
Based on the 2000 US Census Report, InCrisis estimates there are 39.4 million children 12 to 17 year old in the US today. The MECA Study (Methodology for Epidemiology of Mental Disorders in Children and Adolescents) estimated that almost 8.4 million of U.S. children ages 9 to 17 had a diagnosable mental or addictive disorder associated with at least minimum impairment (Table 1). This translates to a prevalence of almost 21% or 1 out of five children. When the diagnostic criteria used to estimate the prevalence required the presence of significant functional impairment, estimates dropped to 11 percent. This estimate translates into a total of 4.3 million youth who suffer from a mental illness that results in significant impairments at home, at school and with peers. Finally, when extreme functional impairment is the criterion, the estimates dropped to 5 percent. This means there are 2 million children in the U.S. with extremely severe functional impairments.
Consequences of Untreated Mental Disorders in Children and Adolescents:
Children and adolescents experience strong feelings of stress, confusion, self-doubt, pressure to succeed, financial uncertainty, and other fears while growing up. For some, divorce, the formation of a new family with step-parents and step-siblings, or moving to a new community can be very unsettling and can intensify self-doubts. For some children and adolescents, suicide may appear to be a solution to their problems and stress.
Depression and suicidal feelings are treatable mental disorders. The child or adolescent needs to have his or her illness recognized and diagnosed, and appropriate treatment plans developed. When parents are in doubt whether their child has a serious problem, a psychiatric examination can be very helpful.
- Suicide is the third leading cause of death in youth ages 15 to 24 and and the sixth leading cause of death for 5-to-14-year-olds.
- More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza and chronic lung disease combined.
- Over 90 percent of children and adolescents who commit suicide have a mental disorder.
- In the United States in the year 2002, almost 4,300 young people ages 10 to 24 died by suicide.
- States spend nearly $1 billion annually on medical costs associated with completed suicides and suicide attempts by youth up to 20 years of age.
- Twenty-four percent of high school students have seriously thought about attempting suicide.
- The rate of suicide for this age group has nearly tripled since 1960, making it the third leading cause of death in adolescents and the second leading cause of death among college age youth.
- More teenagers and young adults died as a result of suicide in 1999 than cancer, heart disease, HIV/AIDS, birth defects, stroke and chronic lung disease combined.
- For every older teen and young adult who takes his or her own life, 100-200 of their peers attempts suicide. Between 500,000 and 1 million young people attempt suicide each year.
- As in the general population, young people were much more likely to use firearms, suffocation, and poisoning than other methods of suicide, overall. However, while adolescents and young adults were more likely to use firearms than suffocation, children were dramatically more likely to use suffocation.
- Almost four times as many males as females ages 15 to 19 died by suicide.
- Most suicide attempts are expressions of extreme distress, not harmless bids for attention. Males take their own lives at nearly four times the rate of females and represent 78.8% of all U.S. suicides.
- 16.9% of students, grade 9-12, seriously considered suicide in the previous 12 months (21.8% of females and 12.0% of males).
- 8.4% of students reported making at least one suicide attempt in the previous 12 months (10.8% of females and 6.0% of males).
- 2.3% of students reported making at least one suicide attempt in the previous 12 months that required medical attention (2.9% of females and 1.8% of males).
- Among 15- to 24-year olds, suicide accounts for 12.9% of all deaths annually.
- For every completed suicide by youth, it is estimated that 100 to 200 attempts are made. Based on the 2003 Youth Risk Behavior Surveillance Survey (YRBSS), 8.5% of students in grades 9 through 12.
- Every 2 hours and 11 minutes, a person under the age of 25 completes suicide.
- Research has shown that most adolescent suicides occur after school hours and in the teen’s home.
- change in eating and sleeping habits
- withdrawal from friends, family, and regular activities
- violent actions, rebellious behavior, or running away
- drug and alcohol use
- unusual neglect of personal appearance
- marked personality change
- persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork
- frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc.
- loss of interest in pleasurable activities
- not tolerating praise or rewards
- complain of being a bad person or feeling rotten inside
- give verbal hints with statements such as: I won't be a problem for you much longer, Nothing matters, It's no use, and I won't see you again
- put his or her affairs in order, for example, give away favorite possessions, clean his or her room, throw away important belongings, etc.
- become suddenly cheerful after a period of depression
- have signs of psychosis (hallucinations or bizarre thoughts)
If a child or adolescent says, I want to kill myself, or I'm going to commit suicide, always take the statement seriously and immediately seek assistance from a qualified mental health professional. People often feel uncomfortable talking about death. However, asking the child or adolescent whether he or she is depressed or thinking about suicide can be helpful. Rather than putting thoughts in the child's head, such a question will provide assurance that somebody cares and will give the young person the chance to talk about problems.
If one or more of these signs occurs, parents need to talk to their child about their concerns and seek professional help from a physician or a qualified mental health professional. With support from family and appropriate treatment, children and teenagers who are suicidal can heal and return to a more healthy path of development.
Approximately 50% of students age 14 and older who are living with a mental illness drop out of high school. This is the highest dropout rate of any disability group.9
Youth with unidentified and untreated mental disorders also tragically end up in jails and prisons. According to a study funded by the National Institute of Mental Health—the largest ever undertaken—an alarming 65 percent of boys and 75 percent of girls in juvenile detention have at least one mental illness.10 We are incarcerating youth living with mental illness, some as young as eight years old, rather than identifying their conditions early and intervening with appropriate treatment.
When children with untreated mental disorders become adults, they use more health care services and incur higher health care costs than other adults. Left untreated, childhood disorders are likely to persist and lead to a downward spiral of school failure, limited or non-existent employment opportunities and poverty in adulthood. No other illnesses harm so many children so seriously.