Gain history of the substance abuse

Mental Health Issues in Children,
Youth and Adolescents
Family and Children’s Service of Greater Lynn, Inc.
Linda Demerjian, LICSW
Jackie Trahan, M. Ed.
Lauren Harless, LCSW
Maria Alvarado, BA
The What and Why of Mental Health in Youth
What is mental health?
Mental Health can be defined as a state of well-being in which every individual
realizes his or her own potential, can cope with the normal stresses of life, can
work productively and fruitfully, and is able to make a contribution to her or his
community (World Health Organization, 2001).
Why is it important?
Mental health issues in youth may lead to poor school performance, school
dropout, strained family relationships, involvement with the child welfare or
juvenile justice systems, substance abuse, and engaging in risky sexual behaviors.
Youth Mental Health Statistics
1 in 5 Children, currently or at some point in their life, have had a seriously debilitating
mental disorder.
Half of lifetime cases of mental disorders begin by age 14.
In a given year, only 20% of children with mental disorders are identified and receive
About 50% of students age 14 and older who are living with mental illness drop out of
high school.
Almost all teens who think about or have attempted suicide have a mental disorder,
including depression, bipolar disorder, attention deficit hyperactivity disorder (ADHD)
or problems with drug or alcohol abuse.
Suicide is the third leading cause of death in youth ages 10 to 24.
According to a 2012 survey, 25 % of middle school youth and 14% of high school
youth in Lynn, MA have “ seriously considered suicide”.
(National Alliance on Mental Illness, 2010)
(National Institute of Mental Health, 2010)
(Northeast Center for Healthy Communities ,2012)
(Nock et al., 2013)
Depression is a serious health problem that can affect people of all ages,
including children and adolescents.
Depression is generally defined as a persistent experience of a sad or
irritable mood as well as “anhedonia,” a loss of the ability to experience
pleasure in nearly all activities.
Major depressive disorder, often called clinical depression, is more than just
feeling down or having a bad day. It is a form of mental illness that affects
the entire person.
Depression changes the way one feels, thinks and acts and is not a personal
weakness or a character flaw.
Children and youth with depression cannot just “snap out of it” on their
own. If left untreated, depression can lead to school failure, substance
abuse, or even suicide.
Indicators of Depression
Grumpy, sad, or bored most of the time.
Does not take pleasure in things he/she used to enjoy.
Weight loss or gain.
Change in sleeping patterns.
Feeling hopeless, worthless, or guilty.
Having trouble concentrating, thinking, or making decisions.
Thoughts of death or suicide.
Lack of energy.
Headaches, stomachaches, loss of interest in friends and activities.
Slower speech or movements.
Anxiety is the feeling of intense, fear, distress and apprehension that appears
out of proportion to the situation. While all children and adults experience
this at one time or another, an actual anxiety disorder is an intensified
reaction of fear or apprehension that affects daily functioning.
Risk factors may be genetics (a predisposition), family history (substance
abuse), traumatic of scarring events, poverty and so forth.
If untreated, the negative experiences of the anxiety compound fears and
symptoms over time.
Anxiety disorders that persist into adolescence and adulthood have a high risk
of substance abuse (American Psychiatric Association, 2000).
Indicators of Anxiety
Difficulty concentrating
Emotional/physical distress
Body Tension
Self-defeating cognitive and
behavioral rituals
Clinging behavior
Sleep and appetite disturbance
School refusal
Feeling out of control
Poor memory
Difficulty effectively coping
Clumsy or accident prone
Sense of impending doom or
Periods of losing time
Startle Response
Attention Deficit Hyperactivity Disorder
A persistent pattern of inattention and/or hyperactivity-impulsivity that is
more frequently displayed for at least six or more months and is more severe
than is typically observed in individuals at a comparable level of development
(American Psychiatric Association, 2000.)
ADHD is one of the most common childhood mental health disorders.
The symptoms of ADHD begin in childhood and often persist into adulthood.
The causes and risk factors for ADHD are unknown, but genetic factors likely
play a role.
(U.S. Department of Health and Human Services, 2011)
Indicators of ADHD
• Often does not give close attention to details or makes careless mistakes in schoolwork, work,
or other activities.
• Often has trouble keeping attention on tasks or play activities.
• Often does not seem to listen when spoken to directly.
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties
in the workplace (not due to oppositional behavior or failure to understand instructions).
• Often has trouble organizing activities.
• Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long
period of time.
• Often loses things needed for tasks and activities.
• Is often easily distracted.
• Is often forgetful in daily activities.
• Often fidgets with hands or feet or squirms in seat when sitting still is expected.
• Often gets up from seat when remaining in seat is expected.
• Often excessively runs about or climbs when and where it is not appropriate.
• Often has trouble playing or doing leisure activities quietly.
• Is often "on the go" or often acts as if "driven by a motor".
• Often talks excessively.
• Often blurts out answers before questions have been finished.
• Often has trouble waiting one's turn.
• Often interrupts or intrudes on others.
(American Psychiatric Association, 2000)
Trauma can be defined as a physical or psychological threat or assault to a
child’s physical integrity, sense of self, safety or survival or to the physical
safety of another person significant to the child (Vermont CUPS Handbook,
2005). Children may experience trauma as a result of a number of different
circumstances, such as
Abuse, including sexual , physical, emotional
Exposure to Domestic Violence
Severe natural disaster (earthquake, flood, fire, and tornado)
War or military actions
Witness to violence in school setting, neighborhood
Personal attack by another person
Severe bullying
Medical procedure, accident, serious illness or surgery
Indicators of Trauma
Difficulty sleeping
Hyper alert and a heightened startle response
Avoidance of physical contact or eye contact
Terrified responses to sight, sound that remind the child/youth of the
traumatic experience (example, the smell of alcohol, police siren, a dog)
Re-enactment of the traumatic experience
Substance Abuse (adolescents)
Who is at greater risk?
 Children and youth who are victims of physical and sexual abuse, usually by
trusted caregivers.
Children and adolescents who are victims of domestic violence in their
families or in a school or community setting.
Risk Factors for Mental Health Issues
•Genetic defects
•Low birth weight
•Chronic physical conditions( i.e. deafness
or blindness)
•Illness (i.e. diabetes or asthma)
•Physical trauma, or exposure to toxic
chemicals or drugs while in the womb
• Low IQ
•Learning difficulties and deficits in sensory
• Previous diagnosis of a mental health
•Extreme poverty
•Over-crowded living condition
•Inadequate schooling
•Neighborhood violence and
•Poor peer relations (i.e. bullying)
•Poor prenatal care
•Young parents/caregivers
•History of family criminality
• History of family mental disorder
•Severe marital discord
•Poor parental supervision and/or discipline
•Childhood maltreatment
(Community Action Network, 2010)
What can we do?
Individual Level
Educate self further about mental
health (know the warning signs).
Monitor youth’s behaviors.
Take into consideration youth’s
developmental stage.
Thoroughly access youth’s
background and situation.
Develop relationships and/or consult
with mental health professionals
(psychologist, psychiatrists and social
Contact caregivers when
concerns/warning signs arise.
If possible, openly discuss mental
health with youth in the schools,
classroom, program, center etc.
Community Level
Conduct meetings, presentations,
conferences and/or conversation
around mental health to increase
awareness and reduce social stigma.
Train staff, childcare workers, school
faculty, parents etc. to recognize the
risk factors and warning signs of mental
health issues.
Collaborate with mental health
professionals to implement or improve
Consider and support policy that
improves access to mental health
Promote tolerance and understanding
of those suffering from mental illness.
Assessment of Youth and Substance Abuse
In adolescents, substance abuse highly correlates with mental health issues, especially
trauma (National Child Traumatic Stress Network, 2008).
Determine if substance abuse is occurring
- During the past 12 months, have you:
Drank any alcohol (more than a few sips)?
Smoked any marijuana or hash?
Used anything else to get high? (includes illegal drugs, over the counter and prescription
drugs, and things that you sniff or “huff”.)
Gain history of the substance abuse
What kinds of substances are/were used?
How often and under what circumstances? (frequency and pattern)
Has anyone expressed concern over your use of alcohol and/or other substances?
Do you have concerns about your use?
Do family members or friends use? Under what circumstances?
Make an appropriate referral
Research recommends treating substance abuse and mental health issues concurrently.
(Massachusetts Department of Public Health Bureau of Substance Abuse Services, 2009)
Mental Health Providers
Determine if substance
abuse is occurring.
Gain a history of the
substance use and
examine for underlying
Make appropriate
referral(s)- substance
abuse counseling and/or
mental health counseling.
Non-Mental Health Providers
Determine if substance
abuse is occurring.
Gain a brief history of
substance use.
Make a referral to a
general mental health
clinician for further
Local Youth Mental Health Resources
Lynn Community Health Center,
Behavioral Health Services
20 Central Ave., Lynn MA 01902
Elliot and Community Human
95 Pleasant St., Lynn, MA 01901
(781) 581-4400
Family and Children’s Service of
Greater Lynn, Inc.
111 N. Common St., Lynn, MA 01902
(781) 581-6614
Children Friends and Family
112 Market St. 2nd Fl, Lynn, MA 01902
(781) 592-5691
Catholic Charities
117 N. Common St., Lynn, MA 01902
(781) 593-2312
Psychiatric Associates of Lynn
270 Union St., Lynn, MA 01901
(781) 268-2200
Mass General at North Shore
Medical Center
57 Highland Ave. Salem, MA 01970
(978) 354-2700
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