I am a special education district director. I have been noticing that more and more teenagers are being diagnosed with depression, particularly those in special education. I have also noticed that some of our students are depressed but they are not getting any mental health treatment. We even had a junior commit suicide this January. He had not received any treatment either. Is this something that is being addressed in other communities?

Worried

Answer:

Dear Worried,

You are not alone in your concern. Suicide is the third most common cause of death in teens, following homicide and accidents. Suicide deaths are more common than the combined total from all natural causes in teens. Therefore, departments of child and adolescent psychiatry are creating programs to screen for and educate teens, their families and school staff about depression and anxiety, as well as other mental illnesses that generally have onset in the late teens.

I know of three programs that have been shown to be effective, although the programs are quite different in the way that they are organized and their target outcomes. Links to informational web sites are at the end of this reply.

Teen screen is a program that is in place in some high schools in quite a few states. It has been shown to be effective in identification and treatment referral of teens with depression and anxiety. It is relatively expensive, since it involves a computerized screening questionnaire that generates a profile about the teen and their level of risk for depression and or anxiety. This also asks questions about substance abuse, including alcohol. The questionnaire used in San Francisco has been modified and screens for eating disorders.

Participation in the screening is voluntary with informed consent obtained from both teens and their parents. Teens found at risk by this screening are given a clinical interview with a mental health professional. If the teen is found to have significant mental illness, they are put in touch with mental health treatment services either through insurance, local mental health offices, or other services depending on their financial situation.

The programs follow up some of the teens identified later in high school. There is some variability among the different programs established throughout the United States.

SOS is an educational program that can be done within the schools or other places such as boys’ clubs or medical clinics. A DVD is shown to the teens and portrays real life situations involving suicide, depression and anxiety. The DVD is described as being liked by the viewers. A discussion follows. This has been shown to be effective in educating teens about mental illness in themselves and their friends. It is relatively inexpensive. In my local community, students in the public high schools have organized themselves into a Teen Mental Health Board and are using this program for all seniors prior to graduation. It is popular and so far has been very well accepted.

The Warning Signs Project is used in New York in the high schools. It is different from the other two programs in that it is educational with the target audience being the teens and all adults working with them, including parents, pediatricians and school staff is part of the school health curriculum. The warning signs are a list of 11 symptoms that include symptoms such as, “drastic changes in your behavior or personality”, “feeling very sad or withdrawn for more than 2 weeks”, and “repeated use of drugs or alcohol”. I do not yet know the outcome of their investigations.

I hope that this information has been helpful. If you are interested in establishing these programs in your school, the web sites should be very helpful.

http://www.teenscreen.org/

http://www.mentalhealthscreening.org/downloads/sites/docs/sos/AJPHarticle.pdfhttp://az.nami.org/newsletter_articles/00003.htm

http://www.apa.org/campaign/july99.html