Addressing developmental and social determinants of mental health in transition-age youth  (2020)

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The quality of mental health care for adolescents entering young adulthood with mood disorders suffers from the historic evolution of systems-of-care for children and adults and the lack of adequate transitional services to link these systems. Historically the two systems evolved independently, with significant differences in assumptions about underlying causes of distress and with discordant treatment methodologies.

The impact of the transition problem on individuals, their families and the community is significant: mental health service use drops by as much as 60% at the age of 18 in general, with even greater declines in minority youth. The disruption in treatment engagement for 16-to-25-year-olds with serious mood disorders is untimely. At this age, major mental illnesses, including bipolar disorder, schizophrenia, and major depression, often first emerge; moreover, these conditions are most treatment-responsive early in the course of illness.  Although programs are developing to address new-onset psychosis in young people, few programs exist for mood (bipolar and major depressive) disorders, despite the fact that rates of depression double between the ages of 13 and 18 years. The fallout is that less than 40 percent of transition-age youth with depression receive treatment. Although bipolar disorder typically begins in this age span, studies suggest it is not recognized for up to 10 years after onset, despite multiple clinical visits.

Through a partnership between Steve Hicks School of Social Work, Dell Medical School Department of Psychiatry, and Integral Care, a program is being piloted at Integral Care to improve engagement and provide targeted support for work and school goals for transition-age youth (age 16-25) who are receiving services for a mood disorder. The evaluation of the pilot, led by research assistant professor Deborah Cohen, will focus upon retention in mental health services, work, school, housing, and the reduction/absence of criminal justice involvement.