There is a blind spot in young adult mental health
The mental health of children and young adults has been particularly affected over the past two years. A system already strained before the pandemic, mental health services in Texas have struggled to keep up with demand. Mental health care providers see a flood of referrals to their programs, resulting in waiting lists for precariously overworked mental health professionals.
Recently, some voices have called for better access to mental health services for vulnerable young people. The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association have declared a national child and adolescent mental health emergency, and the White House has produced a fact sheet on the ‘improved access and care for mental health for young people.
Both reports highlighted suicide, the second leading cause of death among 10 to 24 year olds. The risk of suicide increases with age during this period, and young adults between the ages of 20 and 24 are most at risk.
Each report suggested solutions, including widely used approaches such as school-based services, coordination of care for children and families, and psychiatric consultation for pediatricians. But the reports largely leave out suggestions for creating access and supports for young adults – something that should be there. Excluding young adults from the mental health conversation is all too common and reflects our health systems.
In addition to the disruption, young adults face social isolation and economic challenges as a result of the pandemic. This is also the time when serious mental illness, such as bipolar disorder, usually develops, but young adults are the age group least likely to access or engage in supportive health services. mental. This is a critical gap in services.
Of the American Rescue Plan Act’s billions of dollars spent on mental health, only a tiny fraction is earmarked for young adults. That should change. Rather than exploring and working to fill the gaps in care, we continue to focus solely on expanding the programs already in place. It is simply not enough. We owe it to our young adults – who have borne much of the economic burden of the pandemic, lost “normal” young adult experiences, and are expected to become active members of society with little or no support. We owe them innovative and community-based solutions that prioritize their needs and preferences.
Young adults are often blamed for their lack of commitment to mental health care, an assumption that they flex their newfound freedom. Research suggests otherwise. Almost all health care systems are structured as pediatric or adult providers. These fragmented systems are rarely effective in building transition processes that ensure that young people move successfully between the two, creating a “cliff of service” for emerging adults.
Our research in Texas found that less than 40% of Texas youth receive adult service after leaving children’s services. And less than 10% of these people remain engaged in care by the age of 19.
These results mirror results found in other states. In our interviews with young people in mental health services, they have consistently expressed that their preferences, needs and goals are not being met by either adult or pediatric systems. The experience is worse for young adults who discover access to care because they report that they feel there are no options for mental health care. The result is an extraordinary disengagement of care for this population, an even deeper problem in the context of the pandemic.
In other countries, particularly Australia (Headspace), Ireland (Jigsaw) and Canada (Foundry), mental health care for young adults focuses on the provision of youth-friendly multidisciplinary services in low-income environments. low stigma (eg, community colleges, shopping malls). We need to model these successful approaches within our community with the appropriate political will. Investing in the mental health and well-being of young adults benefits everyone. It reduces the burden on systems such as hospitals and prisons, and stimulates the economy with an influx of healthy and productive adults.
Deborah Cohen is an Assistant Professor at Dell Medical School at the University of Texas at Austin.
Laura Stevens is a Senior Clinical Trainer at the Center for Youth Mental Health at Dell Medical School at the University of Texas at Austin.
A version of this editorial appeared in the San Antonio Express News, Austin American-Statesman, Waco Tribune Herald, Amarillo Globe-News, and Abilene Reporter News.