The United States is facing a child mental health crisis, and Montana is no exception. Untreated or undertreated child and adolescent emotional-behavioral problems often lead to psychiatric disorders in adults, representing a significant public health problem. In fact, mental illness is the No. 1 cause of disability in the U.S. and in Canada, according to the World Health Organization.
By the time our youth turn 19 years old, about 50 percent will have experienced a treatable emotional-behavioral problem. This doesn’t mean that half of our kids need to be medicated — it simply means that a significant proportion of our children and adolescents are at risk for further problems in functioning if untreated.
According to the 2013 Montana Youth Risk Behavior Survey, about 1 in 13 high school students attempted suicide last school year. Based on national statistics, 80 percent of youth who struggle with mental illness go untreated. Interestingly, 75 percent of youth who are able to access treatment do so in a school setting. The number may be even higher in Montana thanks to the Comprehensive School and Community Treatment teams that are present in more than a third of public schools.
We’ve known for decades that genes and the environment interact to either protect us from or make us vulnerable to disease. Fortunately, recent powerful public health studies are yielding data that help us to better understand the conditions in childhood that can make the development of emotional-behavioral problems more likely.
The ACE Study is one of the most significant public health studies in recent history — ACE stands for “adverse childhood experiences.” The study showed that more than 60 percent of the population has been exposed to at least one adverse childhood experience, including various forms of abuse, neglect and family dysfunction. More importantly, the study showed that individuals with higher ACE scores (i.e. exposure to a higher number of adverse childhood experiences) are likely to struggle with poor physical and mental health throughout their lives.
Not surprisingly, childhood exposure to abuse, neglect, and family dysfunction causes emotional-behavioral problems long before these youth reach adulthood. A more recent study out of Spokane, Wash., demonstrated that elementary school students with elevated ACE scores are much more likely to struggle in school. Specifically, 80 percent of K-6 students with three or more adverse childhood experiences were facing academic problems.
Tackling the child mental health crisis requires collaboration across multiple systems: the family system, the school system, the health care system and the legal system. (About two-thirds of youth in juvenile detention facilities have a treatable psychiatric disorder.)
Fortunately, there are local efforts underway to educate professionals and the public about the impact of childhood emotional-behavioral problems on short- and long-term health. For example, the ChildWise Institute is sponsoring a two-day ACE Study Summit in Billings beginning May 29 at the Northern Hotel. Separately, representatives from local health care organizations recently convened to address the impact of adverse childhood experiences in our pursuit of higher quality patient care.
Improving access to child mental health services is the right thing to do and it is a cost-effective public health strategy. Early identification and treatment of children with high ACE scores can help prevent the development of future psychiatric and medical problems.
Eric Arzubi, MD, is a child and adolescent psychiatrist at Billings Clinic.