His outbursts frightened teachers and classmates, but his parents said he was just being a teenager.
Her crying fits and awkward sleeping habits worry her friends, but her mom says she’s just emotional and lazy.
“There’s nothing wrong with my kid.” Mental health professionals hear it every day — the sentiments of parents in denial about their child’s mental illness. The reality, however, is that the line between teenage growing pains and unusual behavior is murky, experts say.
“Some kids change as they go through developmental changes, and we expect that,” said Dr. Nancy Carroll, a child and adolescent psychiatrist at the Zepf Center, a behavioral health agency in Toledo. “But just because you know — or think you know — why they’re declining doesn’t mean they don’t need help with it.”
The recent shooting at Sandy Hook Elementary School in Newtown, Conn., thrust mental health issues into the national spotlight after it was reported the 20-year-old gunman suffered from mental illness.
One in 10 American children suffer from mental illness, often characterized by declining grades, conflicts with family and peers, spending too much time alone, and changes in level of functioning. More common in adults, mental illness affects one in four people ages 18 and older.
Despite its prevalence, a negative stigma surrounding mental illness has deterred people from seeking treatment, out of fear of judgment and stereotyping, said Robin Isenberg, executive director of the National Alliance on Mental Health of Greater Toledo. Only 23 percent of adolescents in the United States who needed mental health treatment had received it in the prior year, a 2002 report released by the federal Substance Abuse and Mental Health Services Administration showed.
Mrs. Isenberg said the incident at Sandy Hook has created a false stereotype about people with mental illness.
“The Sandy Hook incident has people thinking that people with mental health illnesses are violent. That’s not true in most cases,” Mrs. Isenberg said. “Everyone is worried about what people will think if they say they have a mental illness, but mental illness is no different from physical illness. If your child was having trouble breathing or showing signs of the flu, you’d take them to a doctor to be assessed. The brain is an organ of the body. It gets sick just like the heart and the lungs.”
The spectrum of mental illness ranges from the innocuous to the severe, and it includes a wide variety of symptoms from mood and emotional disorders to uncontrollable rage and psychotic breakdowns.
When to treat
Parents of mentally ill children aren’t always sure of when to seek treatment, oftentimes waiting until behaviors are extreme, experts say.
“If parents are concerned, don’t ignore it. Act on it. Don’t wait until they hurt themselves or someone else,” said John R. DeBruyne, chief executive officer of Rescue Mental Health Services in Toledo. “If you’re seeing a [negative] change, something’s wrong.”
Outside of parents, teachers are often the first to notice signs of mental illness. They are trained to notify school counselors or administrators, who in turn notify parents and suggest an assessment. “At that point, it’s left up to the parents,” Mr. DeBruyne said. “We’re a free society. It’s a parent’s choice.”
Lucas County has a number of service providers and advocates for the mentally ill, including the National Alliance on Mental Health, the Zepf Center, and Unison Behavioral Health Group. Rescue also operates several recovery programs, including residential units for both children and adults. And the agency provides crisis care, where teams do on-site assessments and transport patients for safe care.
“Safety is always the most important thing," Mr. DeBruyne said. “Before anything else can be fixed, a person has to be safe.”
Most traditional health insurance policies don’t cover mental health medications and therapy, but in Lucas County, services are provided regardless of ability to pay.
Depending on the diagnosis, treatment could range from therapy — such as behavioral, group, or family — to environmental changes and medication. Once a youth patient reaches adulthood, treatment sometimes becomes more difficult, Dr. Carroll said.
“After they turn 18, they’re adults. Like everybody else, they want to make their own decisions,” Dr. Carroll said. “As parents, there’s not much you can do. They don’t have to take their meds,” Dr. Carroll said. “You can try to have them committed, but they have to be really out of order for that. Oftentimes the patient ends up homeless or in jail.”
Role of jails
As many as 559,000 mentally ill people were housed in state mental hospitals in 1959. During the 1990s, a shift to deinstitutionalize mentally ill people had dropped that number to about 70,000, according to the National Institute of Corrections.
With fewer mental health institutions operating, jail has become the alternative for many people with mental illness. In a 2006 report, the Bureau of Justice Statistics estimated that 705,600 mentally ill adults were incarcerated in state prisons, 78,800 in federal prisons, and 479,900 in local jails.
To combat those numbers, the National Alliance on Mental Health has teamed with local law enforcement officials and the county board on mental health to train officers on how to handle the mentally ill when responding to an emergency. The program, called the Crisis Intervention Team, consists of both single-day and weeklong seminars at which officers learn skills to improve safety when a mentally ill person is involved.
“The skills officers are taught on the job have a countereffect on the person having a psychiatric emergency,” said Scott Sylak, executive director of the Lucas County Mental Health and Recovery Services Board. “Obviously, we believe anybody who breaks the law should be held responsible for their actions, but sometimes when those actions are due to a psychiatric emergency, there are different levels of responsibility that should be considered, such as diversion or treatment.”
To date, more than 450 Lucas County officers of various levels have been trained. Toledo police spokesman Sgt. Joe Heffernan said the department aims to de-escalate situations and seek help for youth who may be mentally ill.
“If it hasn’t reached the point of being violent, or a crime hasn’t been committed, we’ll work through [Children Services Board] and juvenile court to get them and their family some help,” Sergeant Heffernan said. “Obviously, if someone is threatening harm, they can be arrested, but we use some discretion and see what would be best for the child.”
Education and treatment are key when it comes to tackling mental illness. Knowing risk factors and following through with care plans can help.
“Treatment can work, but it has to be taken seriously,” Dr. Carroll said. “I know doctors that have bipolar disorder and ADHD and they function just fine, because they’re educated on their disorders and because of treatment.
“Mental illness is only a problem if you don’t get treated.”
Contact RoNeisha Mullen at: firstname.lastname@example.org or 419-724-6133.