In the ever-evolving landscape of youth mental health, a revolutionary paradigm is emerging, focusing on adolescent screening and prevention within a public health approach (Moran, M., 2022; Stiffman and colleagues, 2010). This innovative approach introduces multisectoral treatment options. With a variety of avenues for treatment, we ultimately have the power to address the root causes more effectively and appropriately. While this concept has yet to gain widespread traction in the field, it holds tremendous promise.
While there are growing calls to universally screen for depression and anxiety (US Preventive Services Task Force, 2022a and 2022b), barriers to universal screening still impede its implementation. An important concern within the health care sector is the unspoken question of adolescent screening follow-up. This inquiry often arises, leading to a thorough exploration of a particular category of treatment, an early intervention approach that transcends traditional diagnosis and has the potential to change the trajectory of mental health conditions. This includes short-term interventions, such as a few sessions dealing with recent loss and grief, as opposed to a formal diagnosis of depression, for example, and subsequent self-medication and addiction. The implications of this innovative approach are profound when treating the patient, but they are not in a system that reimburses diagnosis to a much greater degree than preventive measures.
Despite significant technological advances, including the widespread adoption of virtual and Zoom-based therapy during the COVID era, one may wonder why we are not seeing significant improvements in the mental health of our children. One answer lies in the lack of comprehensive and easily accessible screening tools. These tools can provide informative insights that can help doctors, families, and patients choose better options for care. Earlier identification of mental health disorders leads to more effective interventions of shorter duration.
In the current scenario, a pediatrician is given a short window of 11 to 20 minutes to engage with a patient. Existing screening tools use old pen-and-paper measures that work independently. The result is that separate screening occurs for depression, ADHD, anxiety, and social determinants of health. Through the use of 21st century technology implemented prior to the well child visit, mental health information can be collected on all of these concerns. This allows for meaningful correlations and connections to give the provider a stronger picture of the child’s mental health before the encounter begins.
While there is a growing call for mental health screening, it often falls short by delaying the screening request until age 12 or older. Since half of all cases of mental illness in a lifetime begin before age 14, a doctor and family have limited information about a child’s unique qualities before signs and symptoms appear. Unfortunately, these control barriers lead to a lack of longitudinal information that is a reliable predictor of future mental health.
Before the pandemic, there was a worrying deterioration in youth mental health, highlighted by a 27 percent increase in anxiety and a 24 percent increase in depression from 2016 to 2019, as reported in a JAMA Pediatrics study. The lack of baselines and treatment pathways informed by year-over-year metrics is evident in statistics such as the 11-year gap from onset to diagnosis, with signs and symptoms that can appear as early as age four. This means that for a 6-year-old showing symptoms today, proper diagnosis and treatment may not occur until age 17, resulting in prolonged suffering from kindergarten through high school. Calls for action to reform youth mental health have also intensified, with Surgeon General Vivek Murthy calling the current crisis “the defining public health crisis of our time” and major organizations like the CDC advocating for universal anxiety screening in young people.
Complicating matters further, it is estimated that in the US, there are 350 individuals for every mental health provider. However, these figures come with some drawbacks, as they include active mental health professionals who may no longer be accepting new patients. The growing demand for therapy and the severe shortage of providers raises the critical question of what steps should be taken after screening—”now what?” scenario.
This begs the question: What does early intervention involve? How can we support children before signs and symptoms escalate to a severe stage?
Here is the good news! A public health approach that includes technology-supported screening, prevention, and early intervention can expand the choice of possible health care solutions.
Additionally, schools, GPs, paediatricians and mental health providers can begin to share the burden of care. This approach can help uncover root causes and shorten the path to health and wellness for our teens.
Moran, M. “What does a public health approach to mental health and illness look like?” Psychiatric News. American Psychiatric Association. https://doi.org/10.1176/appi.pn.2022.11.10.32. EPub 2022 Oct 24.
Stiffman AR, Stelk W, Horwitz SM, Evans ME, Outlaw FH, Atkins M. “A public health approach to children’s mental health services: potential solutions to current service inadequacies.” Adm Policy Ment Health. March 2010;37(1-2):120-4. doi: 10.1007/s10488-009-0259-2. PMID: 20039117; PMCID: PMC2874610.
US Preventive Services Task Force. (2022a, October 11.) “Depression and suicide risk in children and adolescents: review.” Retrieved February 2, 2024, from https://uspreventiveservicestaskforce.org/uspstf/recommendation/screening-depression-suicide-risk-children-adolescents#fullrecommendationstart
US Preventive Services Task Force. (2022b, October 11.) “Anxiety in children and adolescents: review.” Retrieved February 2, 2024, from https://uspreventiveservicestaskforce.org/uspstf/recommendation/screening-anxiety-children-adolescents