Children's Mental Health

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What Mental Health Problems Do Children Have?

The Surgeon General emphasizes that mental disorders in children have a complex relationship to developmental processes, biology, and environment -- there is not one clear cause. This complexity means that different children have different degrees of mental health problems. (Source)

Children's mental health problems are distinguished by how much they affect a child's functioning. The Surgeon General identifies:

  • Diagnosable disorders causing at least minimum impairment,

  • Diagnosable disorders causing significant impairment, and

  • Diagnosable disorders causing extreme impairment.

What Do Children's Mental Disorders Look L ike?

Many children with mental health problems have more than one diagnosis, and often they also have educational or learning challenges and deficits in social and adaptive behavior.

Additionally, youth with mental health problems have high rates of alcohol and/or drug use and abuse—SAMHSA reported to Congress that 43% of youth receiving mental health services have a co-occurring substance abuse disorder. (Source)

In Kansas, children (0-12) admitted to state hospitals in 2004 most commonly had the following diagnoses:

  • Bipolar disorder (27%), “other” (22%, including major depressive, disruptive behavior, adjustment disorder) and ADHD (18%) -- Rainbow State Hospital.

  • “Other” (46%, including intermittent explosive and impulse control), ADHD (44%), and ODD (42%) -- Larned State Hospital.

Source: “Co-Occurring Disorders of Substance Abuse and SED in Children and Adolescents,” KU School of Social Welfare (2005)

Serious Emotional Disturbance (SED)

Children and youth with the most severe mental disorders have serious emotional disturbance (SED): "a diagnosed mental health condition that substantially disrupts a youth's ability to function socially, academically, and emotionally."

A youth who experiences serious emotional disturbance is one who meets the criteria in the areas defined below:

  1. The youth is under the age of 18, or under the age of 22 and has been receiving mental health services prior to the age of 18 that must be continued for optimal benefit.

  2. The youth has a diagnosable mental, behavioral, or emotional disorder that has continued for the period of time necessry to meet the diagnostic criteria specified within the most current DSM.
  3. The youth's mental, behavioral, or emotional disorder has resulted in functional impairment, which substantially interferes with or limits the youth's role or functioning in family, school, or community activities, often to the point they are at high risk for out-of-home placement or have been placed out of the home. This includes youth who do not currently have functional impairment but would if they did not have the benefit of treatment or other support services.

Functional impairment is defined as difficulties (internalizing and externalizing) that substantially interfere with or limit a youth from achieving or maintaining one or more developmentally appropriate social, behavioral, cognitive, communicative, or adaptive skills.

Examples of functional impairment: School (for example: in-school suspension, out-of-school suspension, withdrawn at school to the point that performance is impacted), Family (for example: at-risk of out-of-home placement, physical aggression at home, suicidal), and Community (for example: law enforcement contact, unable to or serious difficulty participating in extracurricular activities due to behavior or isolating from peers).

The youth's functional impairment does not qualify if it can be attributed solely to intellectual, physical or sensory deficits.

The youth's functional impairment does not qualify if it is a temporary response to stressful events in the youth's environment.

How Many Children Have Mental Health Problems?

The child population in Kansas in 2004 was 683,491. (Source) Research suggests that 34,174 and 61,514 of these children experience serious emotional disturbance (SED), and 75,184 have a disorder causing significant impairment.

  • 21% of children have a diagnosable mental disorder that causes at least minimal impairment. (Source)

  • 11% of children have a diagnosable mental disorder that causes significant impairment. (Source)

  • Between 5 and 9% of children have a serious mental disorder that causes extreme impairment (Serious Emotional Disturbance-SED). (Source)

Who Are the Children Affected by Mental Health Problems?

In Kansas and across the country, mental health problems affect children of all ages from all ethnic and socioeconomic backgrounds. They are all our children.

Are There Risk Factors for Children's Mental Disorders?

According to the Surgeon General, there are biological AND environmental factors that can “influence—but not necessarily ‘cause’—the mental disorders of childhood.” (Source)

Risk factors for children’s mental health problems include:

Biological Factors:

  • Prenatal damage from exposure to alcohol, illegal drugs, and tobacco: 88,853 Kansas children (13%) are born to mothers who smoked during pregnancy. (Source)

  • Low birth weight: 47,844 Kansas children (7%) have low birth weight. (Source)

  • Inherited predisposition to a mental disorder

External/Environmental Factors:

  • Poverty: 82,018 children in Kansas (12%) live in poverty.(Source)

  • Abuse and neglect: 5,682 Kansas children (8.2 per 1,000) were victims of abuse and/or neglect in 2003. (Source)

  • Exposure to violence and/or traumatic events, such as the loss of family members or close friends: In 2003, 5,781 children in Kansas were in out-of-home placements (8.3 per 1,000). (Source)

  • Unsatisfactory relationships

  • Parental mental health disorder

Children’s mental disorders can also be made worse by factors that limit access to mental health treatment (Source), such as

  • Poverty: 82,018 children in Kansas (12%) live in poverty. (Source)

  • Lack of health insurance: 47,844 Kansas children (7%) do not have health insurance. (Source)

  • Ethnic minority background: 166,934 Kansas children (24%) are non-white. 80,508 of those children (48%) are Hispanic and Latino. (Source)

  • Limited English proficiency: 61,514 Kansas children (9%) speak a language other than English at home, and 13,669 (2%) have difficulty speaking English. (Source)

  • Residence in remote or rural areas: 95 of Kansas’ 105 counties are considered rural. (Source)

  • 28.6% of Kansans (768,337 persons) live in rural counties. (Source)

  • 9.6% of Kansans (258,088 persons) live in frontier counties (20 or fewer persons per square mile. (Source)

Are Kansas Children with Mental Health Problems Getting the Help They Need?

Nationally, only one in five children (20%) with mental health needs receives treatment. (Source)

In 2004, the Kansas mental health system served a total of 33,454 children -- only 4.9% of the child population. (Source) Remember, estimates say 10% of children (75,184 in Kansas) have a mental disorder causing significant impairment.

  • 5-9% of children have SED: In 2004, 17,796 children were served by CMHCs as SED—that is 2.6% of the population, or half of the low estimate of how many Kansas children have SED. (Source)

Even though all ethnic groups of Kansas children are underserved according to prevelance estimates, certain groups have significantly lower rates of treatment than others. (Source)

  • The average rate of mental health utilization for Kansas children across all ethnic groups is 5.2%.

  • Only 2.5% of Hispanic and Latino children receive mental health services. This is the 5th lowest utilization rate, even though they are the second largest ethnic group in the state.

  • Only .71% of Asian children and 1.1% of Native American children in Kansas receive mental health services.

Suicide

Suicide is one of the most tragic effects of mental disorders in children and youth: research suggests that over 90 percent of children and adolescents who commit suicide have a mental disorder. (Source)

2003: In Kansas, 50 persons between the ages of 0 and 24 committed suicide. 84% of these suicides were by males and 68% were committed using firearms. (Source)

  • 0-14: 3 suicides, 4th leading cause of death

  • 15-19: 18 suicides, 2nd leading cause of death

  • 20-24: 29 suicides, 2nd leading cause of death

2004: In Kansas, 59 persons between the ages of 0 and 24 committed suicide. 56% of these suicides were committed using firearms. These deaths accounted for 16% of all suicides in Kansas in 2004. (Source)

Where are Children with Mental Health Problems?

If only 4.9% of Kansas children receive mental health services and prevalence estimates suggest that 21% have diagnosable mental disorders, then where are the rest of these children if not in the mental health system? Children with mental disorders, most of whom are undiagnosed, are frequently involved with more than one service system, particularly

  • Child Welfare/Foster Care,
  • Juvenile Justice, and

  • Special Education, and
  • Substance Abuse.

Each of these systems, as well as children’s families and communities, plays an important role in the promotion, preservation, and restoration of emotional well being of children with mental disorders.


Child Welfare/Foster Care

The Connection Between Foster Care and Mental Health Poblems

In addition to the trauma of being removed from their families, homes, and parents, most of the children in foster care have been exposed to child abuse, neglect, separation, poverty, domestic violence, and/or parental mental illness or substance abuse. These factors put them at “extremely high risk for mental health problems, especially traumatic stress” (Source)

  • Many parents place or allow their children to be placed in foster care in hopes that they will receive mental health services that could not be obtained while in the home. (Source)

Many adolescents who have been in foster care experience problems with substance abuse. This indicates a high probability of mental health problems -- studies have shown that 62% of male adolescents and 83% of female adolescents entering substance abuse treatment have a high rate of emotional disorders. (Source)

  • 17.4% of youth who have been in foster care are in need of treatment for alcohol or drug use, compared to 8.8% of youth who have never been in foster care. (Source)

  • 13.1% of youth who have been in foster care need treatment for drug use, compared to 5.3% of youth who have never been in foster care. (Source)

How Many Children in Foster Care Have Mental Health Problems?

Research suggests that between 40% and 85% of children in foster care have mental health disorders. (Source)

In Kansas in 2005, 6,269 children and youth were served in the foster care system. (Source)

  • The research suggests that between 2,507 and 5,328 of these children have mental health disorders.

Are These Children Getting Mental Health Treatment?

Unfortunately, most of the children in Kansas’ foster care system are not getting the mental health services that they most likely need.

  • 1,081 children served as target population by community mental health centers were in foster homes or therapeutic foster care at some point in the third quarter of FY 2005—this is 17.2% of all children in foster care. (Source: State of Kansas Summary, Children’s Client Status Report, AIMS Field 62 “Residential Utilization”)

  • At the end of the thrid quarter of FY 2005, the mental health centers were serving 997 children as target population in foster homes or therapeutic foster care (15.9% of all children in foster care). 918 of these children were in SRS custody or supervision and 36 were in JJA custody or supervision. (Source: State of Kansas Summary, Children’s Client Status Report, AIMS Field 63 “Current Residential Living Status”)

    • NOTE ON THIS DATA: These figures only indicate the number of children in foster care receiving intensive mental health services. SRS only reports service numbers for “targeted children”—those with serious emotional disturbances—who receive Targeted Case Management or Community Psychiatric Support Treatment.

Juvenile Justice

The Connection Between Juvenile Justice and Mental Health Poblems

According to research, children and youth with mental disorders are at a greater risk for involvement with the juvenile justice system. Across the country, the juvenile justice system has become a holding center for youth with mental disorders, including those who have committed no offense but simply need mental health services.

  • In national survey in 2001, estimates from nineteen states indicated that approximately 9,000 children and youth entered the juvenile justice system to obtain mental health services. Kansas “could not provide the data requested” for this survey. (Source)

  • A 2004 survey indicated that Kansas was one of 33 states in which juvenile detention facilities reported holding youth with mental illnesses without charges against them. (Source)

How Many Youth in the Juvenile Justice System Have Mental Health Problems?

“[E]xisting research suggests that most youth in the juvenile justice system, anywhere from 70 to 100%, have a diagnosable mental disorder.” (Source)

  • Approximately one out of five youth in the juvenile justice system has a serious mental disorder. (Source) This is twice as high as the rate of serious mental disorder in the general population.

  • Additionally, recent estimates suggest that between 3 and 50 percent of children in the juvenile justice system suffer from Post-traumatic Stress Disorder. (Source)

     

In 2004, Kansas JJA served 15,302 juvenile offenders. 3,111 of these youth were placed in a detention center. (Source) Prevalence estimates suggest that,

  • Between 10,711 (70%) and 15,302 (100%) of Kansas’ juvenile offenders have a diagnosable mental health disorder.

  • 3,060 (20%) of all Kansas’ juvenile offenders and 622 (20%) of the offenders placed in detention have a serious mental disorder (SED).

  • Between 450 (3%) and 7,651 (50%) of Kansas’ juvenile offenders suffer from PTSD (Post-Traumatic Stress Disorder).

Are These Youth Getting Mental Health Treatment?

In short, no. In 2004, the Kansas Advisory Group on Juvenile Justice Delinquency Prevention stated that there is a “lack of available mental health programs for juveniles” in Kansas. (Source)

  • In Fiscal Year 2004, only 10.5% (1,612) of the youth served by JJA received Behavior Management services (Level V and VI placements and Therapeutic Foster Care). Behavior Management services comprise the majority of mental health services provided by JJA. (Source)

  • In Fiscal Year 2004, Kansas mental health centers served 78 children with SED who were living in jail or detention. Remember, research suggests that, of the 3,111 youth who were in detention, 622 have SED. (Source)


Special Education

The Connection Between Special Education and Children's Mental Health Problems

Some children with mental disorders qualify for special education services. To be eligible for special education services, a child must meet the criteria for one of 13 federal disability categories defined in the special education law (IDEA 2004).

Most children with mental disorders who are eligible for special education fall under the disability category of Emotional Disturbance (ED).

  • Children with emotional disturbance (ED) exhibit one or more of the following characteristics over a long period of time and to a marked degree that adversely affects the child or adolescent’s educational performance.

    1. An inability to learn that cannot be explained by intellectual, sensory, or health factors,

    2. An inability to build or maintain satisfactory interpersonal relationships with peers and teachers,

    3. Inappropriate types of behavior or feelings under normal circumstances,

    4. A general pervasive mood of unhappiness or depression, or

    5. A tendency to develop physical symptoms or fears associated with personal or school problems.

ED includes children with schizophrenia. It does not apply to children and adolescents who are socially maladjusted, unless it is determined that they have an emotional disturbance.

How Many Children Qualify as ED?

The special education criteria for ED state that a child’s mental disorder must have a significant impact on his/her ability to function (“perform”) in the educational environment. This seems to suggest that many of the same children identified as SED should also be identified as ED. However, both nationally and in Kansas, ED identification rates are substantially lower than SED identification.

  • Prevalence estimates suggest that 11% of children have mental disorders that cause significant functional impairment and 5-9% have mental disorders that cause extreme functional impairment. (Source)

    • In Kansas in 2004, 17,796 children were served as SED. (Source)
  • The national rate of ED identification is 0.73% of the child population. (Source) Across the fifty states, identification rates range from as low as 0.12% in Arkansas to as high as 1.58% in Vermont and 2.51% in the District of Columbia. (Source)
    • In Kansas in 2004, 3,721 children ages 3-21 were identified as ED. That is 0.5% of the total population of children 3-21 (738,298). (Source)

These low identification rates for ED are especially concerning when one considers that schools serve as one of the major providers of mental health services for children. (Source) However, researchers and Kansas practitioners (mental health and education) report only minimal collaboration between schools and community mental health providers, illustrating the problem of service fragmentation for families.

What Are the Educational Outcomes for Children with Mental Disorders?

In a 1995 article, Dr. Mary Wagner reported how long-term research findings reveal that youth with emotional disturbance have consistently poor educational outcomes, compared to students with other kinds of disabilities:

  • “There is no single story to tell about outcomes for students with disabilities; young people with different kinds of disabilities differed more from one another than they did from the general population of youths, and the outcomes they were able to achieve reflected those sizable differences.”

  • “Throughout our work, the outcomes for young people with serious emotional disturbances (SED) have been particularly troubling . . . many of these young people have had a particularly difficult time finding success in school and in adult life.”

This national pattern of poor outcomes for students with ED that Dr. Wagner observed in 1995 still holds true for students in Kansas in 2005 across outcomes related to academic, discipline, and exits from the educational system.

Academic Outcomes

In Kansas, substantially more students with Emotional Disturbance scored below proficient on the 2005 state reading and math assessments than students with all disabilities. (Source: KSDE Planning and Research Department, October 2005) This trend was true for assessments in all grade levels. There was an even larger gap between students with all disabilities and the entire student population. (Source)

Discipline Outcomes

According to the National Longitudinal Transition Study (NLTS)-2, a ten-year national study that began in 2000, students with emotional disturbance have significantly higher rates of being bullied, bullying, being in fights, and being suspended.

  • Nationally, 19.7% of all students with disabilities and 44% of students with ED reported being suspended during the school year -- that is more than twice as many students with ED. (Source)

Kansas data reported to the U.S. Office of Special Education Programs (OSEP) shows that students with ED accounted for a disproportionate percentage of the suspensions among students with disabilities in 2003-2004.
  • 2.91% of ED students received a suspension for more than 10 school days and 2.55% were suspended for days totaling to more than 10 school days. These figures are more than three and a half times greater than the respective 0.83% and 0.7% of students with all disabilities.