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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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