Mental Health

Posted December 31, 2004.

According to former Surgeon General Dr. David Satcher, one in 10 children and adolescents (as many as six million young people) suffer from mental illness severe enough to cause some level of impairment. It is estimated that less than one in five of these children receives needed treatment. Mental health problems are caused by biology—head injuries, chemical imbalance or genetics—the environment—exposure to toxins, violence, loss and stress related to serious hardships— or both. Unfortunately mental health problems are generally not recognized and, thus, often not treated in children and adolescents. The stigma attached to having a mental illness along with lack of information and services available for youth severely limits treatment. If left untreated, mental illness can escalate into serious consequences for the youth, their family, and eventually, the community.

"Mental health is a critical component of children's learning and general health" states the Report of the Surgeon General's Conference on Children's Mental Health. The Surgeon General's National Action Agenda for Children's Mental Health was developed from the conference and commits to:

1) Promote the recognition of mental health as an essential part of child health;

2) Integrate family, child and youth-centered mental health services into all systems that serve children and youth;

3) Engage families and incorporating the perspectives of children and youth in the development of all mental healthcare planning; and

4) Develop and enhance a public-private health infrastructure to support these efforts to the fullest extent possible.

A Substance Abuse and Mental Health Services Administration (SAMHSA) report—http://www.samhsa.gov/news/cl_congress2002.html— to Congress in December 2002, states that most patients with mental health disorders also have co-occurring conditions such as substance abuse and urges primary treatment of both illnesses. In a study involving adolescents, about half of the youth receiving mental health services had a co-occurring substance abuse problem. The SAMHSA report also indicates that diagnosis of depression and conduct disorders primarily co-occur with abuse of substances such as alcohol, marijuana and cocaine.

States—

2002 Legislative Session

State legislatures enacted legislation primarily on Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD) and psychotropic medications at schools for ADD/ADHD. The following is a sample of legislation that passed:

Georgia House Resolution 946 created the Commission on Psychiatric Medication of School-Age children to study and investigate the use of psychiatric medications and their effects on school-age children and provided recommendations for improved oversight of narcotic prescriptions for the state's youth.
Illinois House Bill 3744 (Public Act 02-0663) defined psychotropic and psychostimulant medication and required each school board to adopt and implement a policy that prohibits disciplinary action for the refusal of a student's parent or guardian to administer or consent to administration of psychotropic or psychostimulant medication. The bill does not prohibit school medical staff or professional from recommending that a student be evaluated by an appropriate medical practitioner or school personnel from consulting with the medical practitioner with the consent of the student's parent or guardian.
Virginia House Bill 90 (Chapter 314) required the state Board of Education to develop and implement policies prohibiting school personnel from recommending the use of psychotropic medications for any student. The policies may not prohibit school health staff, teachers or other school professionals from recommending that a student be evaluated by appropriate medical practitioners or from consulting with such with the written consent of the student's parent.
Virginia House Joint Resolution 122 requested that the state Department of Public Health collect data to determine the prevalence of methylphenidate and amphetamine prescriptions used to treat ADD/ADHD in the Commonwealth.

2003 Legislative Session

Enacted legislation included bills on student use of psychotropic medications and school-based mental health programs. The following is a sample of legislation that passed:

Colorado House Bill 1172 required each school board to adopt a policy prohibiting school personnel from recommending or requiring a student use a psychotropic drug or to test or require a test for a child's behavior without prior written permission from the parent, guardian or child. School personnel are encouraged to discuss the child's behavior with the parent or guardian which may include a suggestion that the the parent or guardian speak to an appropriate health care professional.
Oregon Senate Bill 456 (Chapter 485) prohibited K through 12 public school administrators, teachers, counselors, or nurses from recommending that a student seek a prescription for a medication that is prescribed with the intent of affecting or altering the thought processes, mood or behavior of a student.
Texas Senate Bill 491 required the Texas Education Agency, the Texas Department of Mental Health and Mental Retardation, the Texas Department of Health, and the Texas Commission on Alcohol and Drug Abuse to conduct a joint assessment, including recommendations for further development of school-based mental health and substance abuse programs.

2004 Legislative Session

The following is a sample of legislation that passed:

New Hampshire House Bill 551 (Chapter 237) established a committee to study the prescription and use of psychotropic drugs, including Ritalin, in childcare centers, preschools and public schools.
Illinois House Bill 307 (Public Act 98-0892) counties may adopt a $5 mandatory fee where a teen court, peer court, peer jury, youth court or other youth diversion program has been created to pay for the administration and operation of such programs.
New Hampshire House Bill 1397 (Chapter 34) requires the Health Education Review Committee to review the efforts of the New Hampshire Youth Suicide Prevention Advisory Assembly in developing a statewide comprehensive plan for youth suicide prevention.

Depression

Depression is a treatable disease with many symptoms. Generally, people who have low self-esteem, consistently view themselves and the world with pessimism or are overwhelmed by stress, are prone to depression. Depression presents itself in adolescents through sulking, getting into trouble at school, being negative, grouchy, and feeling misunderstood. It can be difficult to determine whether a child is going through a phase or is actually depressed given the amount of changes, both physically and mentally, that adolescents go through.

Depressive disorders affect a person's mood, body and thoughts. There are three main types of depression. Major depression interferes with one's ability to work, study, sleep, eat and enjoy various activities. Dysthmya, which is less severe, involves long term chronic symptoms that are not disabling, but still prevents one from functioning normally or feeling well. Finally, bipolar or manic depressive disorder is characterized by mood changes or swings—severe highs (manic) and severe lows (depression).

Anxiety Disorders

According to the National Institute of Mental Health, anxiety disorders generally manifest themselves early on in children and adolescents.

General Anxiety Disorder begins in childhood or adolescence. Sufferers anticipate the worst and worry all the time about their family, health, or work, even when there are no signs of trouble. Physical symptoms include, fatigue, trembling, muscle tension, headache, or nausea.

Phobias are another disorder that affects children and adolescents. Manifestations of phobias include an unrealistic or excessive fear of an object, situation, or harsh criticism or judgment. As a result, youth with phobias avoid fearful situations or things allowing phobias to interfere with their lives.

Panic Disorder or panic attacks generally occur without cause and include periods of intense fear in conjunction with physical symptoms such as sweating, pounding heartbeat, dizziness, nausea, or a feeling of imminent death.

Obsessive Compulsive Disorder symptoms include, repetitive thoughts and behaviors such as hand washing, counting and arranging and rearranging objects. The youth afflicted with this disorder are generally aware that these actions are senseless and distressing, however, the repetitions are difficult to stop.

Post Traumatic Stress Disorder (PTSD) may occur after someone experiences a traumatic event. These events include abuse, being the victim of or witnessing violence, experiencing a natural or manmade disaster. Sufferers experience the event repeatedly through strong memories, flashbacks, or disturbing thoughts and may overact when startled and have trouble sleeping. (This has been especially prevalent since the 9/11 World Trade Center collapse.)

Eating disorders such as Anorexia Nervosa and Bulimia Nervosa primarily start in young girls and teens, however, cases involving males are on the rise. Anorexics fear becoming fat and self-induce starvation. They experience food preoccupation, carry out food related rituals, and are compulsive about exercising. Bulimics eat large amounts of food in a short period of time then purge. Both disorders are compulsive addictions that involve harmful psychological effects and can eventually lead to death. The National Association of Anorexia Nervosa and Associated Disorders reports that the duration of the disorders can extend past 15 years, especially if left untreated. It is estimated that about six percent of these cases die and only about 50 percent report being cured.

National Association of Anorexia Nervosa and Associated Disorders http://www.anad.org

Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD) are essentially the same disorder where a child or adolescent displays characteristic behaviors that include, poor attention to tasks, impaired impulse control and delay of gratification, hyperactivity, and physical restlessness. These symptoms occur most of the time and interfere with the youth’s ability to function normally in the classroom, in social settings, and at home. According to the Attention Deficit Disorder Association, symptoms must be excessive, long term, surface prior to age 7, and continue for at least 6 months for a child to be diagnosed with ADD/ADHD. This disorder is thought to be caused by biological factors—a chemical imbalance in the brain—and may have a genetic component. The issue of diagnosis is controversial. Some people believe that ADD/ADHD is diagnosed too often and the behaviors could be attributed to technological advancements such as computers or as simple as a child being bored in the classroom. Generally, effects of ADD/ADHD are lessened by medication and therapy to modify behavior and learn coping skills. Approximately 4-6 percent of the population has ADD/ADHD and youth will continue to have symptoms and behavior problems into adulthood.

Attention Deficit Disorder Association (ADDA) http://www.add.org

Click here for Psychotropic Medications at Schools, NCSL, May 2004.

Other Resources:

Click here for NCSL's Mental Health page

Mental Health: A Report of the Surgeon General, 1999 http://www.surgeongeneral.gov/library/mentalhealth/home.html

US Department of Health and Human Services—The Center for Mental Health Services (CMHS)http://www.mentalhealth.org/publications/allpubs/CA-0004/default.asp

US Department of Health and Human Services—National Institute for Mental Health (NIMH) http://www.nimh.nih.gov

Suicide -- Click here for NCSL's Unintentional Injury and Violence (including Suicide) page

Click here for State Suicide Prevention Plans, NCSL Legisbrief March 2004.

NCSL provides the links above for informational purposes only, and they do not necessarily reflect NCSL positions.

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