Adolescence is a time of increased risk for many serious mental health problems, including suicide and substance abuse. The Wisconsin school-based screening initiative evaluated in this study is an important effort to identify adolescents who are at risk and to link them with appropriate services in the school or in the community.
This study, although limited because of its retrospective case design, provides some important information about the pervasiveness of the problem and some clues about the factors that may impede access to care.
It is alarming that only 42% of the adolescents referred for community-based care and 80% of the children referred for school-based treatment had one contact with a treatment provider. The percentages were even lower for both groups who received minimally adequate treatment (defined as three or more visits). Although there is no information on outcomes for the children who were identified as being at risk, the "adequacy" of treatment remains a significant question. It is also interesting to note that adolescents referred for community-based care, despite some evidence of higher acuity (rates of suicide and self-injurious behavior), were even less likely to access services.
The identification of adolescents at risk is an important first step, but the creation of delivery systems that ensure appropriate treatment is also critical. While school-based care is one model, an innovative alternative called Headspace (http://www.headspace.org.au) has been developed by a group in Australia. The program is designed to provide services to adolescents where they spend their time, namely on the Internet and in the community. The online component provides information about mental health problems, self assessments, and access to mental health professionals. Teens are then linked to community centers that provide mental health assessments and treatment in addition to providing other basic medical services.
Whether school-based or community-based, we need to do a better job providing for the mental health needs of this population.
Kayla Pope, M.D., J.D., is a clinical research fellow at the National Institute of Mental Health. She had no relevant financial conflicts to disclose.
