Are the children well? Why the conversations sparked by Robin Williams’ suicide must address the need to promote mental wellness among the nation’s youth

Robin Williams’ suicide has once again brought the issue of mental health to the top of everybody’s news feeds on social media.  Many news stories have pointed to the fact that Williams’ death is indicative of recent trends in suicide nationwide – suicide is up sharply among middle-aged Americans in recent years and just eclipsed homicide as the second leading cause of death among teens for the first time in two decades.  Sadly, nearly 22,000 adults between the ages of 35 and 64 committed suicide in 2010.  However, it is important to realize that the CDC estimates nearly one in four adults in America struggles with mental illness each year, and of Americans will experience a mental illness in their lifetime (including substance abuse).  These numbers may be shocking to some, but what many find most surprising is that nearly half of all lifetime cases of mental illness are estimated to start by the age of 14.

I have spent more than a decade working as a therapist with children and adolescents –mostly in elementary schools– and I can’t count how many times I have had to explain my work to incredulous friends and acquaintances who cannot fathom that children experience mental health problems.  I have been asked more than once, “What do kindergarteners have to be depressed about?!”  Many of us have an image of childhood as carefree, which makes it hard to imagine that anything as pernicious as depression could have its roots in such an apparently idyllic time of life.

Scientists believe that mental illness is often the result of a complex interplay between genetics, biology, and experiences – especially exposure to adversity that health professionals refer to as toxic stress.  Sadly, many young children experience toxic stress on a regular basis.  For example, nearly one in five children in America live in poverty, and a recent report released by Child Trends found that one in eight children under the age of 18 have experienced at least three significant adverse experiences, such as family disruption, substance use or violence in the home, or violence in the neighborhood.  There is also evidence that poverty impacts young adults as well; those living in poverty are twice as likely to report symptoms of depression.  While toxic stress can impact an individual at any age, it is particularly insidious at younger ages when inordinate stress to the maturing brain (remember that parts of the brain that are important for reasoning continue to develop well into the early 20s) can negatively affect development.

While all of this may seem grim, there is good news.  Increasingly, scientists are acknowledging that illness and wellness are two separate constructs, rather than two ends of a single continuum.  What that means is that individuals with mental illness can lead fulfilling lives, particularly when they are able to access effective treatment.

In addition to treatment, we can reduce young people’s chronic exposure to toxic stress, thus reducing their risk of mental illness later in life.  Child Trends recently produced a report for the Robert Wood Johnson Foundation that outlines several recommendations for promoting the mental wellness of America’s young people:

• Relationships with caring adults and the development of positive routines and practices from a very early age are the building blocks of promoting child mental wellness.
•  Many parents and caregivers face serious challenges related to their own mental health; a two-generation approach to supporting young people and their families is critical.
• Because schools play such a central role in the lives of most families, they must actively support children and their families in adopting wellness-promoting routines around physical exercise, nutrition, sleep, and “screen time” as well as positive interpersonal relationships and self-regulation.
• Community-wide, proactive strategies must combat the stigma remaining around the identification and treatment of mental health disorders at all ages, but particularly early in life when effective interventions have the greatest potential to shift trajectories in a positive direction.

Much of the conversation in the past days has understandably been on suicide prevention and raising awareness around depression.  Let’s also take this as an opportunity to re-examine how we think about mental health in this country, recognizing that the foundations for mental wellness are built early in life.