Adolescents underserved by mental health services

By L. Louis Albert

Our community should be aware that mental health services for adolescents are in short supply in the greater St. Louis area with good reason, given the recent dictates of health care delivery. 

With the onset of managed care during the 1990s, adolescents had to meet stricter criteria in order to be admitted into a psychiatric unit. It was no longer sufficient to be suicidal or homicidal with frequent thoughts of wanting to do harm to oneself or to others.  If the adolescent didn’t meet these criteria, the hospital stay was declined and outpatient mental health providers were left to try and provide gap services. Upon admittance,  insurance companies put pressure on hospitals to quickly discharge by stabilizing these young patients largely through the use of strong psychotropic medications.

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Even if an adolescent was hospitalized, (s)he was released after shorter stays. If (s)he didn’t have a therapist and psychiatrist prior to admission, oftentimes the “handoff” to an aftercare professional was dropped or delayed as appointments were, and are, difficult to secure in a timely manner due to lengthy waiting lists. These delays frequently led to additional crises including an increased rate of suicide. In addition, many of these adolescents were unable to return to school in any meaningful way, which worsened their situation and created more stress for the entire family.   

There is, however, a viable solution to fill the gaps and keep the adolescent in a continuum of care, which is one of the keys to wellness. 

Day treatment, although not a new idea, offers an alternative both before and after hospitalization. It provides a solution to reduce unnecessary hospitalization for adolescents with a serious emotional disorder.  Post hospitalization, it can be a solution for reducing re-hospitalization and avoiding unnecessary, expensive, residential treatment and/or a stay in the prison system, which frequently occurs for those living with serious mental illness.

In 2001, the United States Surgeon General estimated that 20 percent of all children and youth would need some form of mental health services during a calendar year and that 6 to 8 percent would be diagnosed with a serious emotional disorder (SED) requiring intensive services. Such disorders include:  depression, bipolar disorder, aggressive behaviors, substance abuse and clinical anxiety.  The SED population is at greatest risk of suicide, homicide, psychosis, hospitalization, juvenile justice involvement, school failure and residential treatment.  

In the adolescent day treatment model, a secure and well-managed environment is created through a multidisciplinary day treatment program that provides customized, integrated, wrap-around services focusing on behavioral change. 

Such an Adolescent Day Treatment Center (ADTC) could be designed for those who have difficulty functioning in mainstream community settings and who need a higher intensity of services than those provided by outpatient counseling services. The goal of such a center would be to improve functioning of adolescents in their daily living. 

Planning is underway through the St. Louis County Children’s Service Fund to seek proposals for the development of this model of care.  Agencies such as Jewish Family & Children’s Service along with Lutheran Family & Children’s Services, Catholic Family Services, Provident, and BJC Behavioral Health will be actively pursuing funding as we provide for the needs of our most vulnerable adolescents in both the Jewish and broader communities. I urge you to keep up and stay informed about progress in securing this highly needed model for the adolescents in our County.  Not only will the adolescent directly benefit, but so will their families and their peers.