School of Medicine and Health Sciences Poster Presentations

Title

Characterizing the Unmet Mental Health Needs of Urban Adolescents

Poster Number

246

Document Type

Poster

Publication Date

3-2016

Abstract

Background: Untreated mental illness among adolescents is a major public health concern. Nationwide, 80% of youth with mental illness are not receiving mental health services.

Methods: Medical records (546 total) were abstracted for patients 16-22 years old with a diagnosis of serious mental illness/serious emotional disturbance (SMI/SED) seen between May 2014 and July 2015. A retrospective review of randomized (n=100) eligible charts was performed to abstract demographics, psychotropic medication use, history of mental health referrals, past hospitalization(s), and resource utilization. Based on the criteria outlined by the 1992 Alcohol, Drug Abuse and Mental Health Services Administration Reorganization Act, patients were categorized into mild, moderate, and severe categories. They were considered “mild” if they had a diagnosis of ADHD, ADD, anxiety, dysthymia, or substance use disorder only; “moderate” if they had a SMI/SED (e.g. bipolar affective disorder, major depression), or a “mild” diagnosis with a comorbid intellectual disability, and/or a previous psychiatric hospitalization; “severe” if they had multiple SMI/SEDs or a hospitalization within the past year. Descriptive statistics were performed.

Results: Our patient sample had a median age of 18.9 years (SD ±1.87) with the majority self-identifying as African American (94%) and publically insured (86%). Thirty-four percent were found to have “mild” mental illness, 55% “moderate”, and 11% “severe”. Forty-two percent of the patients sampled had two or more mental illness comorbidities. Forty-eight percent were currently on psychotropic medication (“mild” 41%, “moderate” 51%, “severe” 55%, respectively) and 30% had a reported Individualized Education Program (IEP) or 504 plan (38%, 25%, 27%, respectively). Fourteen percent had been previously hospitalized for mental illness (0%,15%, 55%, respectively). While 83% of patients were offered referrals (82%, 85%, 73%, respectively), only 40% were being followed by a certified mental health provider (35%, 42%, 46%, respectively).

Conclusion: In our population of largely minority, publicly insured youth, a large proportion of patients are not receiving needed mental health services. Studies have shown that untreated SMI/SED in adolescence leads to more intensive and costly treatment, and increases morbidity in adulthood. Our research demonstrates that despite primary care providers' documented referrals, many adolescents with SMI/SED are not connected to ongoing mental healthcare. There are many barriers to accessing mental health services, including stigma and difficulty navigating a complex health system. Future efforts should focus on care coordination between primary care and mental health services to encourage adolescents with SMI/SED to meet their healthcare needs.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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Presented at: GW Research Days 2016

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Characterizing the Unmet Mental Health Needs of Urban Adolescents

Background: Untreated mental illness among adolescents is a major public health concern. Nationwide, 80% of youth with mental illness are not receiving mental health services.

Methods: Medical records (546 total) were abstracted for patients 16-22 years old with a diagnosis of serious mental illness/serious emotional disturbance (SMI/SED) seen between May 2014 and July 2015. A retrospective review of randomized (n=100) eligible charts was performed to abstract demographics, psychotropic medication use, history of mental health referrals, past hospitalization(s), and resource utilization. Based on the criteria outlined by the 1992 Alcohol, Drug Abuse and Mental Health Services Administration Reorganization Act, patients were categorized into mild, moderate, and severe categories. They were considered “mild” if they had a diagnosis of ADHD, ADD, anxiety, dysthymia, or substance use disorder only; “moderate” if they had a SMI/SED (e.g. bipolar affective disorder, major depression), or a “mild” diagnosis with a comorbid intellectual disability, and/or a previous psychiatric hospitalization; “severe” if they had multiple SMI/SEDs or a hospitalization within the past year. Descriptive statistics were performed.

Results: Our patient sample had a median age of 18.9 years (SD ±1.87) with the majority self-identifying as African American (94%) and publically insured (86%). Thirty-four percent were found to have “mild” mental illness, 55% “moderate”, and 11% “severe”. Forty-two percent of the patients sampled had two or more mental illness comorbidities. Forty-eight percent were currently on psychotropic medication (“mild” 41%, “moderate” 51%, “severe” 55%, respectively) and 30% had a reported Individualized Education Program (IEP) or 504 plan (38%, 25%, 27%, respectively). Fourteen percent had been previously hospitalized for mental illness (0%,15%, 55%, respectively). While 83% of patients were offered referrals (82%, 85%, 73%, respectively), only 40% were being followed by a certified mental health provider (35%, 42%, 46%, respectively).

Conclusion: In our population of largely minority, publicly insured youth, a large proportion of patients are not receiving needed mental health services. Studies have shown that untreated SMI/SED in adolescence leads to more intensive and costly treatment, and increases morbidity in adulthood. Our research demonstrates that despite primary care providers' documented referrals, many adolescents with SMI/SED are not connected to ongoing mental healthcare. There are many barriers to accessing mental health services, including stigma and difficulty navigating a complex health system. Future efforts should focus on care coordination between primary care and mental health services to encourage adolescents with SMI/SED to meet their healthcare needs.