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CHILDREN'S MENTAL HEALTH INDICATORS
"Mental disorders generate an immense public health burden of disability" (USDHHS, 2000). Mental illness has often been ignored or "under-recognized" (USDHHS, 2000) as a significant factor in determining the health of our nation, state, or community. Healthy People 2010 has designated the following goal in relation to improving mental health services.
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GOAL: Improve mental health and ensure access to appropriate,
quality mental health services.
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Table 7-25 shows children's mental health indicators developed by Healthy People 2010 and whether they are currently being tracked overall in Travis County. Some of the indicators are under development. A health indicator is a characteristic of an individual, population, or environment, which is subject to measurement (directly or indirectly) and can be used to describe one or more aspects of the health of an individual or population (quality, quantity and time). The collection of data on a system-wide basis is important in determining the overall mental health of the community.
The indicators that are under development reflect insufficient data sources to track data across the country and /or locally. There may be specific information by some agencies or providers but they are not collected in a systematic approach where there is easy access.
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Indicator 1: Suicide rate
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Suicide is defined as death resulting from a self-inflicted injury with a clear intent to kill oneself (Goldston, 2000, August 14).
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In 1998, children and adolescents are taking their lives at a greater rate in Travis County, than in Texas or the nation.
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Various adverse life events combined with other risk factors may lead to suicide. Although most children and adolescents experiencing one or more suicide risk factors do not respond by attempting or committing suicide, nationwide suicide rates in young people have increased dramatically. In 1997, suicide was the 3rd leading cause of death in adolescents and young adults between the ages of 15 to 24 years. A suicide rate of 12.2 of every 100,000 persons followed unintentional injuries and homicide. For children and adolescents between 10-14 years, suicide was the 4th leading cause, with 298 deaths among 18,949,000 children in this age group. For adolescents aged 15 to 19, there were 1,802 deaths among 19,068,000 adolescents. In the age group of 15-19, there was a ratio of five males to one female. Among people 20 to 24 years, there were 2,384 deaths among 17,572,000 people. In the age group of 20-24, there was a ratio of seven males to one female for completion of suicide (NIMH, 2001, January).
Local data shows that in 1998 there was a 10.3 suicide rate per 100,000 in Travis County between the ages of 15-24. In addition, there was a 1.0 suicide rate per 100,000 in Travis County between the ages of 5-14. In both age groups, 14 children and adolescents took their own lives in 1998 (Epigram TX).
Target: 6.0 suicide deaths per 100,000 population.
Baseline: 10.8 suicide deaths per 100,000 population in 1998 (preliminary data; age adjusted to the year 2000 standard population).
Between 1989 and 1998 the average rate for suicides in Travis County was 12.2 per 100,000. This is more than double the national target. In 1998, the suicide rate was 11.4 per 100,000. The 1998 rate is .8 under the baseline for 1989-1998 and 5.4 over the national target. The 1998 suicide rate for the entire state of Texas is 10.8 and the Travis County suicide rate is .6 over the state's rate. Travis County's incidence of suicide is slightly higher than national prevalence rates, clearly identifying this as a significant indicator of mental health in our community. Children and adolescents are taking their lives at a greater rate in Travis County, than in Texas or the nation (Epigram TX).
Other national related suicide data:
- Suicide rates have increased among persons between the ages of 10 and 19 and among young African American men and women (Center for Disease Control).
- Each year, almost 5,000 people, ages 15 to 24, commit suicide (Children's Defense Fund [CDF], 1998).
- An average of 18 teens complete suicide every day (Cobain and Verdick, 1998, p. 88).
- In 1996, the age-specific mortality rate from suicide was 1.6 per 100,000 for 10-14 year-olds, 9.5 per 100,000 for 15-19 year-olds, and 13.6 per 100,000 for 20-24 year-olds (USDHHS, 1999, p. 152).
- Hispanic high school students are more likely than other students to attempt suicide (USDHHS, 1999, p. 152).
- In the 14-19 year age group, boys are approximately four times as likely to complete suicide, while girls are twice as likely to attempt suicide (USDHHS, 1999, p. 152).
- There is solid evidence that over 90% of children and adolescents who commit suicide have a mental disorder before their death (USDHHS, 1999, p. 154).
- In a 10-15 year follow-up study of 73 adolescents diagnosed with major depression, 7% of the adolescents had committed suicide (USDHHS, 1999, p. 155).
- Depressed adolescents were five times more likely to have attempted suicide, compared with a control group of age peers without depression (USDHHS, 1999, p. 155).
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Indicator 2: Suicide attempts by adolescents
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Suicide attempt is a potentially harmful behavior usually resulting in self-injury but not death (Goldston, 2000). It is estimated that 500,000 young people try to kill themselves every year (Cobain and Verdick, 1998, p. 88).
The Healthy People 2010 utilizes the Youth Risk Behavior Survey to determine baseline and actual data. Texas has conducted a similar Risk Behavior Survey; however, the Texas survey was not conducted in Travis County. It is important to recognize there appears to be no Travis County data related to the number of suicide attempts by adolescents between grades 9 through 12.
Years of research has determined the following (NIMH, 2001, January):
- The ratio of attempted suicides is estimated from 8 to 25 attempts to 1 completion.
- The ratio of attempted suicides is higher in women and youth.
- Mental illness, alcohol and drug abuse, parental separation, or divorce are some of the primary risk factors in suicide attempts.
- Suicide attempts are often "expressions of extreme distress".
- Suicide attempts should always be addressed and never ignored. Immediate mental health treatment must be sought.
- Recent studies have concluded there is ".a 30-fold increase in the risk for suicide in adolescents if there is a gun in the home (About.Com News Center, 2000, May 9).
Target: 12-month average of 1 percent.
Baseline: 12-month average of 2.6 percent among adolescents in grades 9 through 12 in 1997.
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Indicator 3: Eating Disorders
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Anorexia nervosa is the most severe eating disorder and is often life threatening. It is characterized by extreme weight loss, a distorted body image and a pathological fear of gaining weight. Hospital treatment is often needed. Thirty to fifty percent of the patients successfully treated in the hospital relapse within one year. Best practice efforts are currently being researched to develop and test specific interventions that can prevent relapse in these patients (USDHHS, 2000).
Bulimia nervosa is disorder characterized by eating extreme or large quantities of food (binge eating) and then eliminating it (purging). Often self-induced vomiting or the use of laxatives or other medications are used to purge the food eaten (USDHHS, 2000).
- Average age of anorexia onset is almost 14 years (Kagan, 1998, p. 45).
- Anorexia affects 1 in every 100-200 adolescent girls and a much smaller number of boys (Center for Mental Health Services [CMHS], 1998b).
- Bulimia nervosa affects 1-3 of 100 young people (CMHS, 1998a).
- About 90-95% of the cases of anorexia and bulimia nervosa occur in females (drkoop, 1998).
- Anorexia usually develops in adolescence, between the ages of 14 and 18 (drkoop, 1998).
- A new study indicates the possibility that children displaying anxiety disorders between the ages of 5 and 15 may be expressing the first indication of a biological vulnerability for anorexia nervosa (Wellness Web). Anorexia nervosa has the most severe consequence, with a mortality rate of 56% per year (USDHHS, 1999, p. 167).
- The mortality rate from anorexia nervosa is 12 times higher than for other young women in the population (USDHHS, 1999, p. 167).
- About 3% of young women have one of the three main eating disorders: anorexia nervosa, bulimia nervosa, or binge-eating disorder (USDHHS, 1999, p. 167).
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Indicator 4: Primary health care
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In the primary care setting, general practitioners, pediatricians, family practitioners, clinics, and medical hospitals often serve as the first point of contact for children experiencing emotional problems. Often emotional or mental disorders go unrecognized. There is a need to increase education in the primary health care setting. In addition, mental health screenings and assessments need to increase in the primary care setting.
Healthy People 2010 is currently developing data around this objective and it is recommended that Travis County begin to track similar data.
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Indicator 5: Children and Treatment
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For many children and adolescents normal development is disrupted by biological, environmental, and psychosocial factors, which can evolve into a life-long mental disorder. These factors and mental disorders may interfere with education, social interactions, and can significantly impact adult functioning. Expanding effective services for children is an important strategy that involves "promoting effective collaboration across critical areas of support: families, social services, health, mental health, juvenile justice, and schools (USDHHS, 2000). Better services and collaboration for children with serious emotional disturbance and their families will result in greater school retention, decreased contact with the juvenile justice system, increased stability of living arrangements, and improved educational, emotional, and behavioral development" (USDHHS, 2000). Healthy People 2010 is currently developing data around this objective and it is recommended that Travis County begin to track similar data (USDHHS, 2000).
- Only one in five children with a mental illness receives needed services. (Missouri Advisory Council for Comprehensive Psychiatric Services, 2000)
- Two-thirds of children do not receive the help needed (CAN, 1997).
- Approximately 10 percent of children receive mental health services from mental health specialists or general medical providers in a given year (USDHHS, 1999, p. 19).
- Approximately one in five children obtain mental health services from health care providers, clergy, social service agencies, or schools in a given year (USDHHS, 1999, p. 19).
- Twenty-one percent of children ages 9-17 receive mental health services per year (USDHHS, 1999, p. 20).
- Fewer children (2-3% of school-aged children) are being treated for ADHD than suffer from it (USDHHS, 1999, p. 149).
- More than 11 million children in the United States are uninsured (USDHHS, 2000).
- In a study of children receiving treatment, data showed services were received in the following areas: 40 percent in the specialty mental health sector, about 70 percent from schools, 11 percent from the health sector, about 16 percent from the child welfare sector, and about 4 percent from the juvenile justice sector (USDHHS, 1999, p. 180).
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Indicator 6: Juvenile Justice Screening
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Each year, over 100,000 youths are placed in juvenile justice facilities around the nation. In Travis County, Juvenile Offender Substance Abuse Treatment Services (JOSATS) reports the number of youth being referred with mental health issues has nearly doubled between the years 1999 (499) and 2000 (927). Exact numbers of youths with mental disorders among those entering this system are not available. Nationwide the proportion appears considerably higher than in the general population. Some issues related to children and adolescents with mental disorders entering the juvenile justice system are suicide, suicide attempts, and other self-injurious behaviors. The need for qualified mental health professionals to screen and assess youth entering the juvenile justice system is important to ensure all youths with a treatable mental health problem are identified and receive appropriate treatment. Healthy People 2010 is currently developing data around this objective and it is recommended that Travis County begin to track similar data (USDHHS, 2000).
- An estimated 60 percent of teenagers in juvenile detention have behavioral, mental, or emotional disorders (CDF, 1998, March 14).
- Sixty percent of all juveniles referred to out-of-home placement had a mental health, mental retardation, or substance abuse diagnosis (CAN, 1997).
- Thirty percent of annual admissions to the Texas Youth Commission have a serious emotional disturbance (CAN, 1997).
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Indicator 7: Co-occurring Substance Abuse and Mental Disorders
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Comorbid mental and addictive disorders are evident in children and adolescents. Children and adolescents diagnosed with conduct problems, oppositional defiant disorder, and attention deficit/hyperactivity disorder appear to be especially at risk. Often children and adolescents do not become substance abusers until after the onset of a mental disorder (USDHHS, 2000).
It is reported that children and adolescents with drug or alcohol-abusing parents are much more likely to develop similar habits. "The finding that alcoholism and drug dependency tend to run in families is not new. What's unclear is whether a child's increased risk is due to inherited factors or is simply the result of exposure to the behavior. While drug and alcohol abuse in young people is likely to be a combination of both factors, a new report published in the October issue of the journal Pediatrics, bolsters the theory that children exposed to such behavior are more likely to follow in the footsteps of mom or dad" (Reuters Health, 2000, October 2). Healthy People 2010 is currently developing data around this objective and it is recommended that Travis County begin to track similar data (USDHHS, 2000).
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Tracking of Children's Mental Health Indicators
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Out of the seven indicators listed, Travis County has sufficient data to track two indicators. The Health People 2010's goal to improve mental health and ensure access to appropriate, quality mental health services is to be achieved by accomplishing a number of community objectives (some are under development) related to children. Currently there is no broad community process for continually tracking Travis County children's mental health indicators. Although many individual public children's mental health agencies and programs are tracking their own performance, they are only snapshots of the community as a whole. As part of the planning process, a systematic approach to review and adopt indicators, and collect appropriate data should be developed and monitored on an ongoing basis.
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Children's Mental Health Home Page
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