In the evolving field of adolescent mental health, a revolutionary paradigm is emerging that focuses on adolescent screening and prevention within a public health approach (Moran, M., 2022; Stiffman and colleagues, 2010). This innovative approach introduces a multi-sectoral treatment approach. Through multiple treatment pathways, we ultimately have the ability to treat the underlying cause more effectively and appropriately. Although this concept has yet to gain widespread traction in the field, it holds great promise.
Despite growing calls for universal screening for depression and anxiety (U.S. Preventive Services Task Force, 2022a, 2022b), barriers to universal screening continue to hinder its implementation. A significant concern in the health care sector is the unspoken issue of follow-up after screening for adolescents. This inquiry often arises, leading to a thorough exploration of a unique treatment category, an early intervention approach that goes beyond traditional diagnosis and has the potential to change the trajectory of mental health conditions. This requires short-term intervention, such as a few sessions to address recent loss and grief, rather than a formal diagnosis of depression, and subsequent self-medication and addiction. This innovative approach has profound implications for treating patients, but falls short in a system that reimburses diagnostics at much higher rates than preventive measures.
Despite significant advances in technology, including the widespread adoption of virtual and Zoom-based therapy in the coronavirus era, one may question why we are not seeing significant improvements in children’s mental health. One answer lies in the lack of comprehensive and easy-to-use screening tools. These tools can provide informative insights to help clinicians, families and patients choose better care options. Early detection of mental health disorders allows for more effective interventions in less time.
In the current situation, pediatricians are allotted a brief window of 11 to 20 minutes to engage with patients. Existing screening tools use outdated pen and paper measurement methods that operate independently. The result was separate screening for depression, ADHD, anxiety, and social determinants of health. Mental health information on all of these issues can be collected through the use of 21st century technology implemented before a child’s well visit. This allows for meaningful correlations and connections, giving providers a more complete understanding of a child’s mental health status before an appointment begins.
Despite growing calls for mental health screenings, screening requirements tend to fall short in most cases by deferring screening requirements until age 12 or older. Because half of lifetime cases of mental illness begin before the age of 14, doctors and families have limited understanding of a child’s unique qualities before signs and symptoms appear. Unfortunately, these barriers to screening result in a lack of longitudinal information, which is a reliable predictor of future mental health.
A study in JAMA Pediatrics reports that before the pandemic, there was an alarming deterioration in adolescent mental health, with anxiety disorders increasing by 27% and depression increasing from 2016 to 2019 24%. What is evident in statistics such as the 11-year gap from onset to diagnosis is the lack of a baseline and treatment path provided by year-by-year indicators, and signs and symptoms may appear as early as 4 years of age. This means that for a 6-year-old child who presents with symptoms today, it may not be properly diagnosed and/or treated until age 17, resulting in long-term suffering from kindergarten through high school. Calls for action to reform youth mental health are also growing, with Surgeon General Vivek Murthy calling the current crisis “the defining public health crisis of our time” and major organizations such as the Centers for Disease Control and Prevention advocating for General anxiety screening among adolescents.
To make matters even more complicated, it’s estimated that there are 350 people for every mental health provider in the United States. However, these numbers are somewhat flawed because they include active mental health professionals who may no longer be accepting new patients. The increasing demand for treatment and the critical shortage of providers raise a critical question: What steps should be taken after screening—the “what now?” scenario.
This raises the question: What does early intervention mean? How do we support children before signs and symptoms escalate to severe stages?
This is good news! A public health approach that includes technology-enabled screening, prevention, and early intervention can expand the selection of possible healthcare solutions.
Additionally, schools, general practitioners, paediatricians and mental health providers can begin to share the burden of care. This approach can help uncover root causes and shorten youth’s pathways to health and well-being.
Moran, M. “What does a public health approach to mental health and illness look like?” Psychiatry News. American Psychiatric Association. https://doi.org/10.1176/appi.pn.2022.11.10.32. EPub October 24, 2022.
Stiffman AR, Stelk W, Horwitz SM, Evans ME, Outlaw FH, Atkins M. “Public Health Approaches to Children’s Mental Health Services: Possible Solutions to Current Service Inadequacies.” Administrative Policy Mental Health. 2010 Mar;37(1-2):120-4. doi:10.1007/s10488-009-0259-2. PMID: 20039117; PMCID: PMC2874610.
U.S. Preventive Services Task Force. (2022a, October 11.) “Depression and Suicide Risk in Children and Adolescents: Screening.” Retrieved February 2, 2024, from https://uspreventiveservicestaskforce.org/uspstf/recommendation/screening-depression-suicide-risk -children-adolescents#fullrecommendationstart
U.S. Preventive Services Task Force. (2022b, October 11.) “Screening-anxiety-children-adolescents.” Retrieved February 2, 2024, from https://uspreventiveservicestaskforce.org/uspstf/recommendation/screening-anxiety-children-adolescents