Mental Health Care System

Mental Health Care System

The mental healthcare system in the United States is historically fractured. A "silo"-based foundation precludes correlation between varied and integral systems that, collectively, offer a range of services to treat the whole patient. The President's New Freedom Commission on Mental Health roused the debate of the mental health community and rallied them around one goal: providing thorough, coherent, and appropriate treatment to Americans with mental health and substance abuse problems. Particularly needy for this form of collected care is one demographic in particular: teens dealing with drug abuse and alcohol problems. The substance-abusing teen is caught between many cracks: between child and adult, the mental health system and juvenile justice. The ever-developing mental healthcare system in the United States is restructuring to address this failure, approaching the teen from both SAMHSA and affiliated programs as well as through the Justice Department, using individual, family, and developmentally-appropriate forms of treatment to offer a complete system of care.

An integral part of the mental health care system in the United States in its provision for teens with drug and alcohol abuse is its affiliation with the juvenile justice system. Frequently unacknowledged, the justice system plays a key role in not only the treatment but the dissemination of morals administered through the transference of the legal infractions witnessed in drug use and under-age alcohol use.

Because substance abuse runs a fine line between mental health and judicial problems, it necessarily incorporates both systems; in its treatment of teens especially, the fine line between breaking the law and the reasons behind use and biological, mental, and emotional ramifications of it puts the issue under spotlight.

The United States Department of Health and Human Service groups both substance abuse and mental health service provision together in its outreach program, purposely lagging its legal integration with punishment in treatment; inherently, drug users and underage drinkers are breaking the law, but far more important than treating their judicial infraction, treatment is widely regarded for the physical, cerebral, and mental effects of the abuse. To treat cases of alcohol and drug abuse across all ages, SAMHSA instated a nation-wide, unilateral approach, including a Substance Abuse Facility center, a Buprenoprphine physican center in many locations, and a plethora of self-tests to gauge a drinking problem, prescription drug misuse, and drug problem exams.

For the teen, many of these issues are transformed to youth-specific outreach programs, with both family-oriented and individual-oriented paradigms. The President's New Freedom Commission on Mental Health recapitulated the important of treatment through the mental health community for substance abuse and also forced a systematic expansion to include new science and ideas through the new Mental Health Transformation State Incentive Grant Program (MHT-SIG), incorporation of Evidence-Based Practices through implementation resource kits, and programs oriented for children. However, there are two categories that remain unaddressed in a thorough manner by the strategic framework transformation: the group not clearly suffering chemical or emotional imbalance -- those utilizing drugs and therein breaking the law -- and those who know right from wrong, have increased access to illegal substance, and are neither children nor adult -- teens.

Drug and alcohol abuse among the nation's adolescents is a story of struggle and reinvention, a demand for services and a requisite interaction with the law for an end-goal of safe and effective help for America's youth. "An untold story of drug and alcohol abuse among the nation's adolescents," Laura Nissen, a social worker and grant recipient from the Robert Wood Johnson Foundation, said, "is the degree to which the juvenile justice system has become the de facto substance abuse treatment provider for young people in trouble with the law. As such, it struggles to reinvent itself to meet a rapidly growing demand for services that effectively help youths to change their lives."

Critics of the system say its largest problem is inability to get help to those in greatest need, what the Robert Wood Johnson Foundation calls the "haves and have-nots."

Estimates continue to suggest that of the youths in need of substance abuse treatment, only 1% receive the appropriate help.

The effects of the untreated teen with an abuse of either drugs or alcohol are frightening, and the main proponent that unites all sides of treatment debates with the goal of the greater public good: youths abusing substances are 3 to 4 times more likely to end up in Emergency Departments, do poorly in school despite ability and encouragement, engage in disruptive behavior, and come into troubling engagement with the law outside of the substance abuse problems (thievery, violence, truancy, among others).

However, despite their lack of judicial prudence, many of these teens are not put directly into the juvenile system, but instead operate within the mental health system and the justice system since many youths with substance problems have co-morbidities of mental disorders.

Nissen correlates not only the co-occurring presence of mental health problems with the excruciatingly difficult task of targeting, treating, sustaining, and preventing teens with substance abuse disorders in the mental health system, but also a set of factors at the local level that further mar systematic efforts. Among these additions to the local equation are the high availability of drugs and under-age access to alcohol, financial cutbacks that draw from school and community youth programs, an increasing dearth of safe, supervised adolescent activities, economic instability in the family setting, and the ever-increasing role of the justice system to treat juveniles punitively in an effort to preempt future engagements with the justice system.

Further problems exist at the national level, where preoccupation with international issues, the War in Iraq, and the new G-SAVE commission draw attention away from domestic problems in an already polarized environment. Among these furthered, surmounting difficulties are problems of delinquency and the growing costs of substance abuse interventions that work in-hand with efforts for increased public safety and the desire to build strong schools with national approval for success.

In a state of such turbid confusion, the youths needing help are caught in the histrionics of debate between the service-concerned left and the safety-concerned right; while each wants the same end goal -- a happy, healthy nation -- the mechanisms by which to achieve one singular goal have never been more tested in the medical and social service community. Without the proper intervention, acceptance and integration of the emerging evidence-based practices, and accessible systems of help, many teens run the risk of not only falling deeper into their problems with substance abuse, suffocation of the series mental disorders from which they may suffer, addiction, and possible crime to sustain their habits. "Providing substance abuse and related comprehensive services for juvenile offenders is a bargain compared to the long-term costs of the alternative," Nissen urges.

The ties between the juvenile justice system and the mental health system are strong because of the interaction of the teen in both systems, but the confusion of a bi-partied system with dual administration, recommendations, and goals prevents current successes in addressing the problem of teens with substance problems. Inside the Justice System's evidential data lays the sad truth that many of the teens desperately in need of mental health support are instead being shuffled through cells, bars, and cold environments that only perpetuate problems with mental health. By 1999, the USDJ was already noting the broad increase in involvement of juveniles in the justice system because of substance abuse; specifically, a 144% increase in juvenile drug abuse violations and 183% increase in juvenile drug abuse cases among formerly processed juvenile offenders.

These teens either entered the juvenile justice system for the first time at increasingly high rates or were returned to the system as repeat offenders. Not only are the rates for interaction with the system increasing, so are the rates of incarceration. One recent study demonstrated that between 1990 and 2000, incarceration in drug related cases was up by 291%.

Proponents of the justice systems say that incarceration of these cases has been rapidly increasing in recent years because it has become the front-line for addressing the treatment problems for teens dealing with substance abuse and addiction.

Nissen suggests that this data reveals "justice's focus towards youth and drugs is that the juvenile justice system has found itself as the largest single referral source youths in publicly funding substance abuse treatment."

SAMHSA concurs; it laments that because availability of consistent screening, assessment, and substance abuse treatment and attention for co-occurring disorders is so fractured and uneven nationwide, the national problem is worsened and the justice system is forced to bear the brunt, since without proper treatment, underage addicts and abusers are more likely to come into contact with the justice system than available treatment.

Even juvenile probation problems are witnessing the weight of increase, citing substance abuse treatment programs as one of their four top expansion needs.

Ultimately, the system is overwhelmed. Before the expansion of the New Freedom Commission in 2001, the Justice system was forced to find a way in which to operate successfully as the nexus between the juvenile justice system and public health, mental health, and substance abuse programs. As a result, the juvenile justice system has been actively involved in the expansion of community-based treatment programs across the nation, particularly best-practice programs that might be adopted on the road to future reform; community assessment centers, juvenile drug courts (already in place in Florida, most particularly in Miami-Dade), integrated case management, graduated sanctions, and strength-based approaches.

These actions on behalf of the justice system not only spurred reinvigorated local strength, but also national attention in such a way that the system is growing into a comprehensive, integrated net of care.

At a local level, the needs of a teen in mental health or abusive crisis has needs so complex that they can defy solution by any once agency, no matter how capable. Most community services tend to occur in "silos" of treatment, where one endeavor takes control and fails to interact well with others. With teens in addictions and substance abuse situations, they are already split between systems: child and adult, juvenile justice and mental health, needing parental support and spreading solitary wings; it is the role of a sufficient system of provision to recognize this particular spread and break down silos to work in an integrating fashion. The Staten Island Mental Health Society is an example of this cooperation; the Children's Community Mental Health Center, which treats young teens and sometimes those as old as 21, combines school-based counseling, special education, family counseling, and summer services to reach out and touch the teen in all aspects of life, working between agencies that might otherwise be ignored.

Family involvement in teen treatment is also an important part of long-term success in youths in any type of the service system. Substance abuse in a child can be a moment of familial crisis, but can be even worse when that abuse is part of the family situation; stigma, legal intervention, and incongruous families can make bringing relatives into the treatment fold a monumental task. Frequently, other children, jobs, and situations preclude a parent's ability to navigate the silos of care so rampant in the mental health system. SAMHSA, as restructured by the New Freedom Commission, makes a strategic attempt to plan, attend, and involve families in the mental health and abuse treatment of their teens.

The SAMHSA system provides not only pamphlet and counseling support in all their offices, including their "Family Guide to Keeping Youth Mentally Healthy and Drug Free," it also provides continued support on their website, allowing for an outreach opportunity that might inhibit the stigma felt in seeking initial physical help. The SAMHSA program also stresses the importance of knowledge about drugs and issues affecting teens, available in the National Clearinghouse for Alcohol and Drug Information, but also about making the time to talk in a 15-minute-daily campaign called "Make Time to Listen ... Take Time To Talk."

In each case with drug treatment, SAMHSA involves the National Institute on Drug Abuse and the National Institute of Alcohol Abuse and Alcoholism in dealing with teens with drug and alcohol problems. Additionally, it provides a nationwide collection of Substance Abuse Treatment Facilities with family-based outreach programs. Services are offered not only in English but also in Spanish, as well as other locationally-specific languages, to help support the family and give each member the opportunity to be involved in the child's case, treatment, and operate as full-partners per the Commision's guide.

In addition to involving families in the substance abuse treatment of teens, developmentally appropriate programs are of the utmost importance. Because teens neither want to be associated with children nor are as developed or mature as adults, they require not only age-specific medicinal treatment, but also development-specific paradigms for approach. "They have a developmental need to be involved as partners in their treatment planning," writes Nissen, " and often provide powerful insights into their situation that professionals might miss. Because a youth has made some bad decisions -- it doesn't mean he or she is incapable of learning and modeling better community norms given an inviting opportunity."

The APA, Medscape, Journal of Counseling and Development, Kaiser Foundation, and the U.S. Department of Education all offer a variety of expert-supported, evidence-based practices to achieve teen-appropriate involvements that not only demand the attention of the attending counselors, but fully incorporate the child into the treatment reality.

The ultimate foundational key to the mental health system for teens with substance abuse problems in drugs and under-age alcohol is engaging and retaining the teens in treatment. In many cases, particularly as a result of the juvenile justice system's involvement in teens with substance abuse problems, a teacher or judge ordering treatment does not guarantee that the teen will cooperate and carry it out. Nissen warns, "especially if a youth has had multiple previous contacts with the system, special efforts must be made to overcome cynicism and skepticism about the potential of any professional helper to tell him/her anything that he or she hasn't heard before."

Using qualified staff to address gender and cultural concerns as a source of strength and confidence and reinforcing the internal power of the individual in the teenager is an important part of the process, building on his or her strengths in order to gain emotional access to the mental disorders behind the addictions.

Teens with drug abuse and alcohol problems are in a systematic Catch-22: they are almost adults, but still children. Caught between two ages, they are also welded between two systems, that of Juvenile Justice and that of Mental Health. As a result, the Mental Health system of America is structured to include substance abuse and is a particular focal point for treatment of adolescent abuse. The mental health care system is currently in a state of transition, as fostered by the President's New Freedom Commission on Mental Health exacted under the first administration of George W. Bush, that changes the structure from singular, silo-based opportunities for treatment to an integrated web of approaches that treat the whole teen, from family to person, addiction to disorder. With the support of foundations like the Carter Center and the Robert Wood Johnson Foundation, communities nationwide are able to put the President's challenges into action, providing a coherent, complete system of treatment for teens with substance abuse problems in the mental healthcare system.

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