Mental health and Illness in Adolescence and childhood: The Time is Now.

By Kebo Zhang: April 4 2018

What initially originated as a concept thought of by the Greek philosopher Plato around 427-347

B.C, the idea of a regulated education curriculum has since become a foundational aspect of

modern day society.1 The process of attending an educational community (commonly known as

school) during childhood has become a critical step in the development and transition into

adulthood for many teenagers.2 According to the National Institute of Health, high quality

education during early childhood years has further been shown to not only correlate to future

success, but also aid children to grow into healthier adults.3 However, while the intake of

knowledge for students is important, the notion of student mental health, in the form of an

adequate social support system, is arguably even greater.4 Having a successful community of

family members, teachers and peers has proven critical in motivating students to maintain

healthy behaviors, both academically and outside the school environment.5

Mental health is an often overlooked, yet utterly essential aspect of everyday life.

Statistics by the National Institute of Mental Health estimate approximately 350 million people

worldwide that suffer from depression of some sort; mental health issues and depression are in

fact the leading cause of disability.6 According to the World Health Organization (WHO), mental

health is 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.” 7 As such, it’s important to realize that

mental health is a broad topic with implications on vastly different areas of life. Those suffering

from poor mental health not only find themselves more prone to stress, but also more susceptible
to physical health disparities and chronic illnesses as well (ie Asthma, diabetes, headaches,

gastrointestinal disorders).8 While mental health is considered vital for productivity and quality

of life, it’s impact is further enhanced for those in adolescence due to the onset of puberty.9

During puberty, not only do children need to cope with neurological and hormonal imbalances,

the physical maturation process coupled with the societal and environmental responses to such

changes may invoke drastic alterations in children’s perception of themselves, their mental

health and overall experience.10 These changes in turn can provide very real consequences on

academics, health and future success as adults. According to surveys by the American College

Health Association, an uncanny direct relationship was found between those suffering from poor

mental health and the corresponding measures of academic success.11

With these implications in mind, the significance of mental health as a global and country

wide issue has only increased in modern society. While there has undoubtedly been a rise in

mental health visibility, the overall awareness and treatment of these problems are still lacking.

Recent publications by the Journal of Pediatrics has detailed an estimated 37 percent rise in

instances of Major Depressive Disorder from 2005 to 2014.12 Despite these jumps in mental

health, there is however an alarming lack of corresponding increase in mental health treatment

according to the National Surveys on Drug Use and Health.13 Likewise, similar studies by the

Huffington post reported that approximately 9.5 percent of those surveyed had no health

insurance that contained access to a therapist or psychiatrist specialized in mental health.14 These

statistics in 2014 when compared to 2006 showed an approximate 5.5 percent increase (9 to

9.5%).15 Similarly, approximately 10 percent of the population experienced both delays in

mental health treatment, and insufficient mental health coverage.16 Compiling this data in a

broader perspective, there has become a very clear trend in depicting a lack of mental health
coverage and professionals in a modern society where today’s adolescents are experiencing

deteriorating levels of psychological health. Fascinatingly, it’s also important to note that of the

adolescents with serious mental health disorders, the lack of trust adolescents have of their

respective officials account for 25 to 33 percent of adolescents that forgo needed mental care,

opting instead to deal with it alone. This lack of mental health emphasis in assuming that these

psychological problems can be dealt with alone, and will soon “go away” merely worsens the

already urgent issue of deteriorating health in students.

 On a societal scale, mental health in adolescents has had direct consequences on the

future of workforce and productivity. In fact, the very definition of mental health as defined by

the World Health Organization encompasses the ability to work productively. For many

teenagers, mental health issues if left untreated often escalates, exacerbating into long term

chronic conditions found most commonly in a form of depression.17 Children, for many, are

regarded as the future of society, and the cost of lower efficiency and productivity in the work

place can be substantial given the astounding rates of mental health prevalence at present.

Already, mental health based suicide has risen for adolescents from the third to second leading

cause of death as of 2015.18 Economically, a 1990 study by the National Center for

Biotechnology information (NCBI) has portrayed an economic burden quantifiable to 53 billion

dollars based on depression alone, of which 33 billion can be attributed to the cost of lower

productivity as a result of mental illness.19 These estimates, given recent trends, have

undoubtedly risen in the modern era.

Alternatively, lack of adequate for care for today’s youths not only create negative

outcomes for the adolescents themselves, but consistent mental illness in a volatile school

environment can in turn pose as a societal threat to others.20 In 2001, 15 years old Charles

Andrew Williams went on a killing spree with a 0.22 caliber revolver in Santee High School,

California, succeeding in killing 2 people and injuring a multitude of others.21 While, there a

multitude of reasons for why those in adolescent years decide to go into violence, an extremely

large factor behind these actions is a mixture of merciless bullying, depression and mental illness

regarding the hopeless of their scenario.22 This, at least, was the case for Charles Andrew

Williams. Astonishingly, 67 to 70 percent of those in the Juvenile Justice System possess some
form of diagnosable mental disorder.23 These changes in perception and mindset of students can

have profound impacts on their actions in a public setting.

While there are no definite answers in addressing mental health issues in adolescence,

this issue brief will cover a series of tentative responses on both the behavioral, structural and

political level.

Sleep on Mental Health

 Sleep is a critical part of everyday life. Daily sleep cycles provide essential benefits to

both the physical and mental health. In fact, countless studies have consistently reported the

significance of sleep on memory consolidation, physical repair of blood vessels, and healthy

pathogenic immunity.24 From a neurological standpoint, studies by Harvard Medical School has

shown an uncanny correlation between mental health disorders and severity of sleep

deprivation.25 Of those with depression, 65 to 90 percent experience some sort of sleep

disorder.26 Similarly, a subsequent longitudinal study portrayed that those suffering from sleep

deprivation were four times more likely to develop major depression going into adulthood.27 For

teens and adolescents, the consequences of sleep is even more dire. Compared to the 7 to 9 hour

range for adults, the recommended amount of sleep for teens is higher ranging from 8 to 10 hours

of sleep each night.28 This higher range for adolescents is in part due growing changes in

physical health as a result of puberty and maturation. Unfortunately, while the need for sleep is at

an all time high, the reality of school, stress and work for many adolescents result in below than

average sleep schedules. In fact, studies by the National Institute of Health estimates that only 9

percent of teens in the United States meet the recommended amount of sleep for adolescents.29

87 percent of high school students suffer from sleep deprivation and of those, 20 percent of the

student population get by with 5 hours of sleep or less per night.30 From a mental health

perspective, a 2010 study by the Journal of Youth and Adolescence has found that for each hour

of sleep lost, teens pose a 38 percent increased risk of feeling sad and hopeless and 58 percent

increase in suicide attempts.

While there is a myriad of reasons for sleep deprivation in adolescents, a growing factor

is found in the disparity between biological process of maturation and the earlier start times

exhibited by many academic institutions. During puberty, the circadian rhythm (internal clock
that regulates sleep cycle) of students gets notably delayed accounting for physical changes in

the body; as a result, many students find it more and more difficult to sleep until 11 pm or later.31

This combined with earlier start times of school (usually around 7 am) ensures only a limited

time period for adolescents to sleep while also ensuring adequate hours of sleep.

A probable solution on a legislative scale thus is to have schools lower their starting

times in order to allow more sleep for adolescents as a way to account for this biological change.

Longitudinal and cross-sectional studies by NCBI were done comparing the success and

outcomes of students who were given more time in the morning to prepare versus those with

usual early start times. While difficult to measure, these studies generally portrayed a consistent

positive correlation between later school start times and an improvement in academic

performance, reduction in depression, improved attendance and all around less engagement in

risk behaviors.32 To date, there has also been no negative outcomes that came out of delaying

school start times.33

While the concept of having later school start times seem straightforward, the logistics

behind implementation poses some thought to be considered. In particular, many K-12 school

districts have a complex system of transportation set in place to allow bus access to all

students.34 By changing the start time of one school (ie high school), plans must be set in place to

ideally change the start times of elementary and middle schools as well to ensure school busses

would be able to get to all grade levels.35 Likewise, another issue to take into account is the

necessity to allocate time for after school activities and practice for those invested in

extracurriculars.36 Daylight is a really large issue, and many fear that by delaying school start

times, the after school practice times would also be shifted back thus limiting the time available

for students to participate in extracurriculars.37 Despite these obstacles many districts face, the
success in adopting later start times are irrefutable. While not universal, policies statements have

already been issued by the American Academy of Pediatrics in 2014.38 Similarly, real life

successful examples of changes in school policy have already been established from institutions

across the country. Perhaps the most relevant of those is the Solebury School in PA whose

decision of later start times has successfully allowed 75 percent of students to sleep later and

have breakfast, while more than half of the student population also reported significant

reductions in stress.39 For those interested in this approach, plausible actions in order to invoke

change may be to get in contact with the board of directors in discussing the feasibility of such

improvements in the community.

Community and Federal based Structural Responses

An alternative response to the issue of mental health is a method of addressing the

constant stigma that permeates the concept of mental illness to allow for higher rates of treatment

and compliance of those afflicted to come out and recognize poor mental health as a very real

problem. The definition of stigma is generally characterized as a negative stereotype,

connotation or prejudice that results from a misconception about mental health.40 The idea of

stigma as it relates to mental health can be compartmentalized into two parts, public stigma and

self-stigma.41 While public stigma deals with the reaction the general populace may have upon a

certain mental illness, self-stigma focuses upon the prejudice and self-deprecation those with

poor mental health do to turn against themselves.41 While there are currently existing legislation

on a federal scale such as the Americans with Disabilities Act of 1990 and Mental Health Parity

and Addiction Equity Act of 2008, such prohibitive legislation do little in helping stave the

personal opinions of the public.42 Instead, a better response, as proposed by Patrick Corrigan

director of the National Consortium on Stigma and Empowerment, is to have elevated

educational awareness of mental illness and subsequent exposure and contact with those

suffering from poor mental health in order to realize the prevalence and gravity of psychological

health.43 These awareness and contact campaigns, through having speakers that can relate to

students about poor mental health, serve the purpose of humanizing and normalizing the idea that

mental illness and depression as a whole is a very much recoverable condition.44 The results of

these campaigns serve to not only reduce the general stigma of depression, but also educate those

suffering of proper methods in treatment (including prevention of fatalities such as suicide).45 It’s

important to note that for the purpose of campaigning and public awareness, a community based

approach should be emphasized including the active participation of teachers, peers and even

other family members in order to ensure a strong support system for those in afflicted.46

However, while public and educational awareness campaigns serve as a great first

response on a community level, solutions focused solely on mental health is often deemed

insufficient. Perhaps the largest problem in dealing with mental health is the lack of active

treatments for patients suffering from poor mental health.47 Statistically, 70 percent of

adolescents that are impacted by poor mental health do not receive treatment.48 For many

adolescents that come from diverse socioeconomic backgrounds, the school environment is

oftentimes the defacto mental health system for children.49 Yet while awareness helps to bring

out and make students realize that mental health is a problem, lack of funding and resources

make schools very much ill equipped to treat or take any action regarding afflicted patients.50 On

the federal level, the program most involved with funding and aid for mental health is known as

the Substance Abuse and Mental Health Services Administration (SAMHSA).51 Funding for this

program in recent years however have been cut in no small part due to president Trump’s policy

plans.52 Improved funding for such policies and subsequent prioritizing for the problem of
mental health while incentivizing psychiatric professions as a favorable vocation can serve a

great deal in improving resources necessary to treat patients.53

Mental health as a whole is a rising epidemic that undoubtedly plays a large role in

overall quality of life. For adolescents, this concept is even more relevant due to the high

prevalence of depression and psychological disorders among the teens (21.4 % of all youths

between 13 and 18).54 Effective treatment of mental health for students provide profound

implications not only for the community as a whole, but also as an a generational impact as the

future decision makers of society. While this is an admittingly convoluted and multifaceted

issue, the initiatives addressed in this issue brief provide for a comprehensive response and

introduction to the issue at large.

Endnotes: 6. "Depression: Facts, Statistics & You." Healthline.

Accessed April 04, 2018.

1. LeapE-mail, Dennis, Joel Hilliker, Jeremiah
https://www.healthline.com/health/depression/fac
JacquesE-mail, Gerald Flurry, Stephen FlurryE-
ts-statistics-infographic.
mail, Gerald FlurryE-mail, and Dennis Leap. "The
7. "Mental Health: A State of Well-being." WHO.
Surprising Origin of Modern Education."
Accessed April 04, 2018.
TheTrumpet.com. Accessed April 04, 2018.
http://www.who.int/features/factfiles/mental_h
https://www.thetrumpet.com/210-the-
ealth/en/.
surprising-origin-of-modern-education.
8. Chavira, Denise A., Ann F. Garland, Sandra Daley,
2. "Early Childhood Education Programs Help
and Richard Hough. Journal of Developmental
Children Grow up to Be Healthier Adults." Eunice
and Behavioral Pediatrics : JDBP. October 2008.
Kennedy Shriver National Institute of Child
Accessed April 04, 2018.
Health and Human Development. Accessed April
https://www.ncbi.nlm.nih.gov/pmc/articles/PM
04, 2018.
C2626436/.
https://www.nichd.nih.gov/about/overview/dire
9. "Mental/Emotional/Social Changes Through
ctors_corner/prev_updates/032814.
Puberty." Mental Help MentalEmotionalSocial
3. Ibid
Changes through Puberty Comments. Accessed
4. "Importance of Family and Community
April 04, 2018.
Involvement Continues to Grow." Importance of
https://www.mentalhelp.net/articles/mental-
Family and Community Involvement Continues
emotional-social-changes-through-puberty/.
to Grow - SEDL Letter, 40 Years of SEDL's
10. Ibid
Building Knowledge to Support Learning, Volume
11. "NAMI." Home. Accessed April 04, 2018.
XVlll, Number 3, December 2006. Accessed April
https://www.nami.org/Blogs/NAMI-
04, 2018. http://www.sedl.org/pubs/sedl-
Blog/September-2017/The-Importance-of-
letter/v18n03/family_comm.html.
Maintaining-Mental-Health-in-Col.
5. "Why Family and Community Involvement Is
12. Schrobsdorff, Susanna. "Teen Depression on the
Important." Skip Navigation. Accessed April 04,
Rise Says New Pediatrics Study." Time.
2018.
November 16, 2016. Accessed April 04, 2018.
https://www.education.nh.gov/instruction/scho
http://time.com/4572593/increase-depression-
ol_health/health_coord_family.htm.
teens-teenage-mental-health/.
13. Ibid https://consumer.healthday.com/encyclopedia/

14. Holmes, Lindsay. "Mental Illness Is On The Rise depression-12/depression-news-

But Access To Care Keeps Dwindling." The 176/depression-and-violence-in-teens-

Huffington Post. April 17, 2017. Accessed April 645005.html.

04, 2018. 22. Ibid

https://www.huffingtonpost.com/entry/mental- 23. Schwartz, Susan. "Also of Interest." NCCP |

illness-is-on-the-rise-but-access-to-care-keeps- Adolescent Mental Health in the United States.

dwindling_us_58ee9a13e4b0da2ff85de60a. June 01, 2009. Accessed April 04, 2018.

15. Ibid http://www.nccp.org/publications/pub_878.htm

16. Ibid l.

17. "The Negative Effects of Going Untreated for a 24. "Sleep Deprivation and Deficiency - Why Is Sleep

Mental Health Disorder." Desert Hope. Accessed Important?" National Heart Lung and Blood

April 04, 2018. Institute. Accessed April 04, 2018.

https://deserthopetreatment.com/co-occurring- https://www.nhlbi.nih.gov/node/4605.

disorders/going-untreated/. 25. Harvard Health Publishing. "Sleep and Mental

18. "Suicide." National Institute of Mental Health. Health." Harvard Health. Accessed April 04,

Accessed April 04, 2018. 2018.

https://www.nimh.nih.gov/health/statistics/suici https://www.health.harvard.edu/newsletter_arti

de.shtml. cle/sleep-and-mental-health.

19. Chopra, Prem. International Journal of Mental 26. Ibid

Health Systems. 2009. Accessed April 04, 2018. 27. Ibid

https://www.ncbi.nlm.nih.gov/pmc/articles/PM 28. "Teens and Sleep." National Sleep Foundation.

C2649890/. Accessed April 04, 2018.

20. Stuart, Heather. World Psychiatry. June 2003. https://sleepfoundation.org/sleep-topics/teens-

Accessed April 04, 2018. and-sleep.

https://www.ncbi.nlm.nih.gov/pmc/articles/PM 29. Gregoire, Carolyn. "5 Scary Health Effects Of

C1525086/. Sleep Deprivation During The Teen Years." The

21. Udesky, Laurie. "Depression and Violence in Huffington Post. January 31, 2018. Accessed

Teens." Consumer HealthDay. January 20, 2018. April 04, 2018.

Accessed April 04, 2018. https://www.huffingtonpost.com/entry/7-scary-

 ways-sleep-deprivation-affects-teen-physical- 41. Ibid

and-mental- 42. "Stigma of Mental Illness: Where Can Public

health_us_55a7bd07e4b04740a3df0fb3. Policy Step In?" Chicago Policy Review. May

30. Ibid 05, 2014. Accessed April 04, 2018.

31. "Sleep and Teens." UCLA Sleep Disorders http://chicagopolicyreview.org/2014/05/05/stigm

Center. Accessed April 04, 2018. a-of-mental-illness-where-can-public-policy-step-

http://sleepcenter.ucla.edu/sleep-and-teens. in/.

32. Wheaton, Anne G., Daniel P. Chapman, and 43. Ibid

Janet B. Croft. The Journal of School Health. 44. Ibid

May 2016. Accessed April 04, 2018. 45. "Public Awareness Campaigns About Depression

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC and Suicide: A Review." Psychiatric Services.

4824552/. Accessed April 04, 2018.

33. Ibid https://ps.psychiatryonline.org/doi/full/10.1176/p

34. "Eight Major Obstacles to Delaying School Start s.2009.60.9.1203.

Times." National Sleep Foundation. Accessed 46. Avasthi, Ajit. Indian Journal of Psychiatry. 2010.

April 04, 2018. https://sleepfoundation.org/sleep- Accessed April 04, 2018.

news/eight-major-obstacles-delaying-school- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC

start-times. 2927880/.

35. Ibid 47. Friedrich, Bettina. "Raising Awareness of Mental

36. Ibid Health Issues Is Not Enough." The Conversation.

37. Ibid April 03, 2018. Accessed April 04, 2018.

38. Wheaton, 32 https://theconversation.com/raising-awareness-

39. "Success Stories." Start School Later. Accessed of-mental-health-issues-is-not-enough-89794.

April 04, 2018. 48. Schwartz, 23

http://www.startschoollater.net/success- 49. "The Hidden Mental Health Crisis in America's

stories.html. Schools: Millions of Kids Not Receiving Services

40. Corrigan, Patrick W., and Amy C. Watson. They Need." The 74 The Hidden Mental Health

World Psychiatry. February 2002. Accessed Crisis in Americas Schools Millions of Kids Not

April 04, 2018. Receiving Services They Need Comments.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC Accessed April 04, 2018.

1489832/. https://www.the74million.org/the-hidden-mental-
 health-crisis-in-americas-schools-millions-of-

kids-not-receiving-services-they-need/.

50. Ibid

51. "Federal Budget for Mental Health &

Addictions." National Council. Accessed April

04, 2018.

https://www.thenationalcouncil.org/topics/federal

-budget/.

52. "How Drumpf's Budget Will Affect People with

Mental Health Conditions." Mental Health

America. February 15, 2018. Accessed April 04,

2018.

http://www.mentalhealthamerica.net/blog/how-

trumps-budget-will-affect-people-mental-health-

conditions.

53. Baum, Stephanie, Arundhati Parmar, Juliet

Preston, and Erin Dietsche. "A New Bill Wants

to Incentivize Psychiatrists, Hospitals to Adopt

EHR for Mental Health Patients." MedCity

News. August 05, 2017. Accessed April 04,

2018.

https://medcitynews.com/2017/08/incentivize-

psychiatrists-hospitals-to-adopt-ehr-for-mental-

health-patients/.

54. "NAMI." NAMI: National Alliance on Mental

Illness. Accessed April 04, 2018.

https://www.nami.org/learn-more/mental-health-

by-the-numbers.