Examining President Obama’s Proposed Funding for Adolescent Mental Health Programs

BlogHealthApr 11 2013

In President Obama’s 2014 budget, he proposes $235 million in new mental health spending primarily for efforts to address adolescent mental health issues in school settings. As Congress considers whether/how to fund in the area of adolescent mental health, it will be important to understand some basic facts about how many adolescents face mental health challenges, dispel some common misunderstandings, and consider some of the serious implications.We would be wise to avoid the assumption that all, or most, people with mental illness are prone to violence.  Nevertheless, we should not ignore that they are sometimes intertwined.  Who can seriously believe that Loughner, Holmes, or Lanza are not young people who are severely mentally disordered?

As a society, we have for far too long danced around the issue of mental illness, regarding it with shame or embarrassment, if not outright denial.  Let’s get real: mental illness is common.  Among our adolescents, ; three-quarters of all mental illness are apparent by age 24.  In most cases, it is the young people (and, empathically, their families and friends) who suffer.  But, occasionally, if left untreated (more common than not), illness erupts as violence—toward oneself or others.

Child Trends has just released a Research Brief that highlights one aspect of this connection.  In the longitudinal study it summarizes, one out of four adolescents reported symptoms of moderate-to-severe depression and/or suicidal symptoms.  By the third “wave” of the study, these adolescents were now young adults.  Those who had the depressive or suicidal symptom as teens were significantly more likely than those who did not to have experienced violence in their sexual relationships, and to report that they or their partners had been sexually unfaithful.   A number of demographic variables were controlled for in the study, strengthening the credibility of a unique association between earlier depressive/suicidal symptoms and subsequent damaged relationships.  I stress, however, than even among the group with adolescent depressive/suicidal symptoms, most did not experience relationship violence or infidelity.

Sadly, though, violence is also a prominent feature in many children’s lives in America.  Recently released data from an authoritative national survey show that one in seven (14 percent) of 12- to 17-year-olds have been victims of violence or have witnessed violence in their neighborhood.  This is according to parents, so we can guess that, if anything, these figures are conservative.  Other data show that more than a third of all violent victimizations in the U.S. are categorized as “intimate partner violence.”

But it’s more complicated still.  Repeated exposure to violence (or other traumatic stresses) alters the developing brain—in ways still incompletely understood, but including an increased risk for depression and other mental illnesses, into adulthood.  We must interrupt this pernicious cycle, or live with costly and tragic consequences.

It is a misperception that schools themselves are dangerous places for children; young people are much more likely to be victims of violence at home, or on the streets of their neighborhoods.  Since schools are natural settings for reaching significant numbers of children, it makes sense for the  Administration and Congress to fund programs that improve recognition and treatment of youth struggling with  mental illness. These efforts can  create a climate of trust, communication, and caring that can begin to address the damage to children already inflicted by violence.  These are responses informed by the “what works” evidence.