Minnesota Title V MCH Needs Assessment Fact Sheets

Children and Adolescents

Promoting Mental Health and Suicide Prevention

September 2004

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Size of the Problem

Nationally, almost 21% of youth aged 9-17 have a diagnosable mental or addictive disorder resulting in minimum impairment; with 11% suffering severe functional impairment [1].

In Minnesota, an estimated 145,000 youth aged 9-17 have a diagnosable disorder and approximately 69,000 have a functional impairment due to a mental illness [2].

Among children with mental disorders:

  • 13% are anxiety disorders
  • 10% are disruptive disorders
  • 6% of mood disorders
  • 2% are addictive disorders [3]

In Minnesota, from 1998 to 2002, suicide was the third leading cause of death for 10 – 14 year olds in Minnesota (30 deaths) and the second leading cause of death for 15 –19 year olds (170 deaths) [4]. Among 10 –19 year olds, 58 percent of all suicides were carried out by firearms [5].

For every completed suicide by an adolescent, there are many more attempts that require hospitalization or emergency room treatment and many attempts that do not require or receive medical attention.

Seriousness

Minnesota’s younger children have lower levels of behavioral and emotional problems, compared to national samples, but higher levels for older youth. However, it is difficult to accurately measure how many children and adolescents receive treatment for mental health problems because of the fragmented mental health care system [6].

However, it is estimated that fewer than 1 in 5 children who suffer from a mental illness severe enough to cause impairment receive treatment [7].

In 2003, approximately 4.5% of children age 12 or younger enrolled in an HMO received any mental health services compared to 11% of 13-17 year olds. Less than 2% of these children received inpatient services, with an average length of stay of twelve days [8].

Mental disorders were the sixth leading cause of emergency department visits among 15-19 year olds in Minnesota in 2001 [9].

Among 5-14 year olds, mental disorders were the sixth leading cause of emergency department treatment but the leading case of hospitalization in Minnesota in 2001 [10].

The Minnesota Student Survey asks a series of questions to measure students’ emotional well-being and distress. The 2001 survey found that the majority of students (71%) did not report high levels of distress; however 10% reported high levels of distress on three or four of the questions [11].

The Minnesota Student Survey also asked about suicide attempts. Overall, 7.3 percent of Minnesota ninth grade students reported they had tried to kill themselves in the past year, and another 15.9 percent said they had thought about killing themselves but made no attempt. Girls were twice as likely as boys to report having attempted suicide (10 percent and 4.5 percent, respectively). American Indian youth (14.5 percent) and Latino youth (12.2 percent) reported the highest rates of attempted suicide among racial/ethnic groups. Students who were currently living with one parent or no parent and students with a chronic mental or physical health condition also reported high rates of attempted suicide [3].

Disparities

Children below 200% of poverty report higher levels of behavioral and emotional problems compared to higher income youth [12].
  Minnesota United States
For all incomes
Ages 6-11:
3.7%
6.3%
Ages 12-17:
10.6%
7.4%
Below 200% of poverty
Ages 6-11:
4.6%
9.3%
Ages 12-17:
19.3%
10.3%
Above 200% of poverty

Ages 6-11:
3.4%
4.2%
Ages 12-17:
8.3%
5.9%

In 2001, Minnesota’s county-based, publicly funded mental health system served over 20,000 children [13]. While American Indian, African American, Asian and Latino children make up 16 percent of the state’s general child population, they comprise 22.4 percent of children in the publicly funded children’s mental health system [14]. Work still needs to be done to assure that services are appropriate and timely. Racial and ethnic minority populations are less likely to have access to available mental health services, to receive needed mental health care and often receive poor quality care [15].

Children within the juvenile justice system have a high prevalence of mental disorders. In one study, 66% of boys and nearly 75% of girls in juvenile detention had a least one psychiatric disorder. High rates of depression and dysthymia were also identified in 17% in boys, 26% of detained girls.

The suicide rate for American Indians of all ages in Minnesota was nearly twice as high as for any other racial/ethnic group, with an age adjusted annual rate of 17.4 per 100,000. Among adolescents and young adults, suicide rates were three times higher in the American Indian community than in other racial/ethnic groups [16].

In 2001, American Indian and Hispanic 12th graders were more likely to report suicide attempts than other racial/ethnic groups, at 21 percent and 18 percent respectively. The rate of reported suicide attempts among African Americans (13 percent) and Asians (10 percent) was also higher than the overall rate [17].

The 2001 Minnesota Student Survey indicated that the percentage of students with special health needs who have tried to kill themselves is two or more times that of children without special health needs regardless of grade or gender.

Geographic Disparities
Children and adolescents in non-metro counties face additional barriers to mental health treatment as most of these counties have a shortage of mental health professionals; specifically child psychiatrists [18].

In Minnesota, there are 4.6 child psychiatrists for every 100,000 children, compared to 6.73 for every 100,00 children in the United States as a whole [19].

Numerous studies have shown that untreated mental health problems can develop into more serious psychosocial impairments as the child matures, placing them at risk for school failure, dropping out, and being placed in more restrictive settings (e.g., juvenile detention facilities and care and treatment centers) [20].

Untreated mental health problems impact the child, family, schools and communities emotionally and financially and have serious implications for both short term and long-term quality of life.

In 2001, the leading cause of hospitalization in Minnesota for children aged 5 to 14 years were mental disorders – accounting for more than 15,000 hospital days and 25 million dollars in expenditures. Mental disorders were the second leading cause of hospitalization for youth aged 15 to 19 years old - accounting for 33,000 hospital days and 45 million dollars [21].

Interventions

“Intervening Early to Prevent Mental Health Problems” provides nurse visits to the homes of high-risk women when their pregnancy begins and for the first year of the child’s life. Visit by visit protocols are utilized to help mothers adopt healthy behaviors and to responsibly care for their children. Follow up 15 years later with the children demonstrated 54% to 69% reduction in arrests and convictions, less risky behavior and fewer school suspensions and destructive behaviors. The key feature is a trained nurse, rather than a paraprofessional who visits the home.

The use of developmentally appropriate mental health screening protocols in multiple settings should be mandated. Locations include primary care clinics (including Child and Teen Check-Ups), public health home visiting, the Follow-Along Program, WIC Clinics, child care and preschool programs (including Headstart), Early Childhood Special Education and Preschool Screening.

In the report entitled Mental Health: A Report of the Surgeon General (National Institute of Mental Health, 1999), the Surgeon General suggests that schools become “portals of service” for children and families. The report encouraged schools to develop a range of multiple resources including school-based services, mental health and social services to address the needs of children and youth experiencing mental health or addictive disorders.

  • School-based mental health services can include prevention-focused activities to create a healthy school environment, selective interventions with groups of students whose circumstances place them at higher risk for emotional or behavioral health problems, as well as diagnosis and treatment of individual students with specific health needs [22]. It has been demonstrated that school-based programs were more likely to serve minority and poor children than community-based clinics [23].

Mental health literature has revealed effective and promising school-based practices in six areas:

  • Enhancing teacher capacity for addressing problems and for fostering social, emotional, intellectual, and behavioral development;
  • Enhancing school capacity to handle the variety of transition concerns (e.g., early childhood education, before- and after-school programs, vocational and career education, and programs to facilitate transition to middle school, high school, and between regular and special education);
  • Prevention, responding to and minimizing impact of crises, e.g., school-wide and classroom programs to reduce school violence, create safe schools, and foster resiliency;
  • Enhancing home and family involvement, e.g., parenting and adult education;
  • Building community linkages and collaborations, e.g., community outreach, mentoring, volunteer program, and school-community partnerships;
  • Providing special assistance to students and families, (e.g., school-based, school-owned, and school-linked services) [24].

The range of mental health services provided to rural consumers over a telemental health network is virtually limitless and includes all of the same services that can be provided in person. Telemental health also has broad application as an education and training tool for mental health staff, and as a way to bring special interest groups, including consumers and family members, together for information and support. Practitioner experience and findings from program evaluations suggest that telemental health improves continuity of care for rural consumers, increases family and consumer involvement in treatment, and reduces lengths of stays and re-admission rates to state psychiatric facilities. Participant satisfaction surveys reveal that consumers perceive telemental health services as worthwhile, of high quality, and worth continuing [25].

Engaging professional organizations in educating new frontline providers in various systems in child development and training them to recognize early symptoms of emotional or behavioral problems could enhance identification [26].

The U.S. Surgeon General’s Call to Action to Prevent Suicide, the National Strategy for Suicide Prevention, and the Minnesota Suicide Prevention Plan promote goals and objectives in youth suicide prevention including:

  • Increase public awareness and knowledge regarding extent and warning signs of suicide and symptoms and the treatability of depression, other mental disorders, and substance abuse.
  • Increase training to people who regularly come into contact with youth regarding at-risk behavior and referral to effective treatment.
  • Increase availability and access to mental health services.
  • Reduce access to suicide methods (firearms, knives, poisons, etc.) among youth exhibiting suicide warning signs.
  • Increase opportunities for youth at risk to strengthen social networks (adult and peer support, etc.) and social competencies (coping, conflict management, help-seeking, etc.).
  • Increase environments (schools, faith communities, worksites, etc.) that reduce stigma associated with suicide and mental disorders and that promote help-seeking. The SOS High School Suicide Prevention Program is a school-based suicide prevention program that has been shown to reduce suicidality in a randomized, controlled study [27].
  • Reduce the number of repeated, sensational youth suicide media reports that glorify, memorialize, or venerate the deceased, that discuss methods used and simplistic explanations, or that use dramatic photographs (site of suicide, funerals, etc.).
  • Increase the number of schools that develop and utilize suicide postvention crisis plans, including opportunities for students to process grief appropriately and keeping student memorials few and brief.

Status

The state and the vast majority of local public health agencies have established mental health and well being as a public health priority.

The Minnesota Children with Special Health Needs Program (MCSHN) provides multidisciplinary development and behavior evaluations for approximately 180 children per year in Greater Minnesota. Most of the children are referred by their local school districts. Preliminary analysis of an evaluation of the Development and Behavior Clinics results in parents reporting improved school performance for nearly 80% of the children seen in clinic, improved behavior at school for 75% of the children and improved behavior at home for 73% of the children.

The Minnesota Department of Human Services has implemented mental health screening for children found to be at the greatest risk such as: developmental assessment of children 0-3 who have been abused/neglected, homeless children, delinquent children, children in need of protection, and youth in chemical treatment [28]. The Minnesota Medical Assistance Mental Health Benefit Set for children is very comprehensive, offering many types of community based services in many locations.

School districts are implementing the procedure of meeting with parents of children who have been removed from school for 10 cumulative school days in a school year to discuss a mental health screening (for the child) with parent permission [29].

Co-locating mental health providers in primary care clinics and educational settings could improve access to screening, diagnosis and treatment. Some Minnesota communities are using Family Services Collaborative dollars to fund school services such as social workers, family facilitators and early childhood mental health therapists.

The Mental Health Leadership Committee and the Infant Mental Health Committee developed under the auspices of the Minnesota Department of Education Division of Special Education and comprised of state agency representatives, parents, mental health professionals, and local education and school health representatives recommended the development of a process for interagency teaming and coordination enabling access to school and community mental health services as needed for children and youth with disabilities, age birth to 21.

In 2000, at the request of the Minnesota Legislature (Ch. 245, Art.1, Sec. 3), the Minnesota Department of Health issued a report on suicide in Minnesota, including a state suicide prevention plan.

In 2001, the Minnesota Legislature provided MDH with $1.1 million annually to begin implementation of the state plan, including the awarding of competitive grants. The 2002 Minnesota Legislature reduced grant funding for this initiative by $123,000. The primary focus of this funding is grants for community-based programs to implement evidence-based suicide prevention strategies targeting high-risk populations.

References

1. National Institute of Mental Health. (2001). Blueprint for change: Research on child and adolescent mental health: Report of the national advisory mental health council’s workgroup on child and adolescent mental health intervention development and employment.
2. Children’s Defense Fund Minnesota. (2004). A special report from Minnesota KIDS COUNT, a project of Children’s Defense Fund Minnesota. Online resource: www.cdf-mn.org/PDF/KidsCountData_04/MentalHealthData.pdf Attn: Non-MDH Link
3. National Institute of Mental Health. (2001). Blueprint for change: Research on child and adolescent mental health: Report of the national advisory mental health council’s workgroup on child and adolescent mental health intervention development and employment.
4. Minnesota Department of Health. (2004). Suicidal thoughts and attempts among Minnesota teens. Population Health Assessment Quarterly, 4(2).
5. Minnesota Department of Health. Center for Health Statistics. Minnesota Health Statistics annual reports, 1999 through 2002.
6. Children’s Defense Fund Minnesota. (2004). A special report from Minnesota KIDS COUNT, a project of Children’s Defense Fund Minnesota. Online resource: www.cdf-mn.org/PDF/KidsCountData_04/MentalHealthData.pdf Attn: Non-MDH Link
7. National Institutes of Health. (1999). Brief notes on the mental health of children and adolescents. Online resource: www.medhelp.org/NIHlib/GF-233.html Attn: Non-MDH Link
8. Minnesota Department of Health. (2003). HEDIS. Online resource: www.health.state.mn.us/divs/hpsc/mcs/hedishome.htm
9. Children’s Defense Fund Minnesota. (2004). A special report from Minnesota KIDS COUNT, a project of Children’s Defense Fund Minnesota. Online resource: www.cdf-mn.org/PDF/KidsCountData_04/MentalHealthData.pdf Attn: Non-MDH Link
10. ibid
11. ibid
12. ibid
13. Minnesota Department of Human Services’ Community Mental Health Reporting System, Calendar Year 2001.
14. ibid
15. Minnesota Department of Education. “Minnesota’s Self-Improvement Plan”. February 2002.
16. For this statement, data is based on all suicides between 1990 and 2002 for persons 15-24 years old. Minnesota Department of Health, Minnesota Vital Statistics Interactive Queries-IQ. Accessed 3/30/2004.
17. Minnesota Department of Health. (2004). Healthy Minnesotans Special Report: Is Minnesota gaining or losing ground: A progress report on Minnesota’s public health improvement goals.
18. Children’s Defense Fund Minnesota. (2004). A special report from Minnesota KIDS COUNT, a project of Children’s Defense Fund Minnesota. Online resource: www.cdf-mn.org/PDF/KidsCountData_04/MentalHealthData.pdf Attn: Non-MDH Link
19. ibid
20. Minnesota Department of Education. “Minnesota’s Self-Improvement Plan”. February 2002.
21. “Five Leading Causes of Hospitalization in Minnesota 2001”. Minnesota Hospital Association.
22. www.healthinschools.org. [Attn: Non-MDH Link] “School-Based Mental Health Services: A Select Bibliography”; website accessed on 6-2-04.
23. v Nastasi BK, Pluymert,D, Varjas, K, Moore, RB. Exemplary Mental Health Programs: School Psychologists as Mental Health Service Providers. 3rd edition. 2002; National Association of School Psychologists. p.xiv.
24. ibid.
25. Smith, H., Allison, R., (2001). Telemental health: Delivering Mental Health Care at a Distance. US Department of Health and Human Services. http://telehealth.hrsa.gov/pubs/mental/home.htm. [Attn: Non-MDH Link] Accessed 7/25/04
26. Report of the Surgeon Generals’s Conference on Children’s Mental Health: A National Action Agenda, December, 1999
27. Aseltine, R., DeMartino, R. (2004). An outcome evaluation of the SOS suicide prevention program. American Journal of Public Health, 94: 446-451.
28. DHS Bulletin
29. Minnesota Department of Education: Summary of Chapter 294 2004 Omnibus K-12 Education Policy Act.