Mental Illness in Youth Either Untreated or Undertreated

Caroline Cassels

November 25, 2013

The majority of US teens with psychiatric disorders go untreated, and when treatment is provided, it is rarely delivered by a mental health specialist, new research shows.

Results from a national survey of teens' mental, emotional, and behavioral disorders and service use shows that fewer than half (45%) of respondents with psychiatric disorders received any kind of mental health service.

The survey also revealed large variation in treatment rates, depending on the type of mental disorder. Youth with attention-deficit/hyperactivity disorder (ADHD), conduct disorder, or oppositional defiant disorder were more likely to receive treatment, whereas those with anxiety were least likely to be treated. There was also a wide variation in treatment rates by race, with black youths significantly less likely to be treated for mental disorders than their white counterparts.

"It's still the case that in this country, people don't take psychiatric conditions as seriously as they should ― this, despite the fact that these conditions are linked to a whole host of other problems, " lead investigator E. Jane Costello, PhD, Duke University, Durham, North Carolina, said in a statement.

The study was published online in Psychiatric Services on November 18.

Child Psychiatrist Shortage

According to investigators, unlike adults, children may receive mental health services from many agencies whose primary responsibilities do not include mental health care. Previous research has suggested that only about 1 in 3 children with a need for mental health care receive it and that there is often a significant time lag, in some cases years, between symptom presentation and receipt of first mental health service in this population.

To examine 12-month rates of mental health service use, the investigators analyzed data from 10,148 adolescents aged 13 to 17 years who were participants in the National Comorbidity Survey Adolescent Supplement (NCS-A), a survey of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental, emotional, and behavioral disorders and service use.

The investigators found that in the past 12 months, only 45% of adolescents with psychiatric disorders received some form of service. The most likely were those with ADHD (75.8%), conduct disorder (73.4%), or oppositional defiant disorder (71.0%). Those least likely to receive service were teens with specific phobias (40.7%) and any anxiety disorder (41.4%).

Teens with any mental disorder were most likely to receive service in a school setting (23.6%) or a general medical setting (10.1%). By comparison, 22.8% received care in a mental health setting.

In addition, teens with any disorder received services in juvenile justice settings (4.5%), by providers of complementary and alternative medicine (5.3%), and in human services settings (7.9%).

Further, the investigators note that black teens were significantly less likely than their white counterparts to be treated for mental disorders.

According to Dr. Costello, the results underline the need for more child mental health professionals.

The researchers point out that the number of child psychiatrists has not increased significantly in recent years, and she added that these results "confirm the seriousness of the problems that need to be solved in order for young people to have access to needed mental health care."

"We need to train more child psychiatrists in this country. And those individuals need to be used strategically, as consultants to the school counselors and others who do the lion's share of the work," said Dr. Costello.

The authors' disclosures can be viewed in the original article.

Psychiatr Serv. Published online November 18, 2013. Abstract

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