Youth with mental health disorders often experience difficulties in a variety of settings including within their own families at home, in school, and in the community.
Families
Frequently, because of their behavior, youth with mental health disorders pose challenges to parents and siblings and are sometimes singled out and blamed for family distress and disruption. Family relationships often become strained because parents and caregivers do not know how to help their children or themselves. The parental relationship is challenged, which may lead to marital discord. The challenges may affect the family’s relationship with relatives as well as its social network, which may isolate the family from potential sources of support. Sometimes this cycle of difficult family interactions leads to social isolation.
School
Some youth with mental health disorders have a difficult time succeeding in school. It is usually not because they do not want to succeed. Instead, behaviors, thoughts, and emotions related to their disorders interfere with their ability to do well. These same problems often lead to disciplinary actions in school even though the cause of the difficulty may be related to their mental health.
Elementary and Middle School
Youth with mental health disorders are more likely to be unhappy at school, be absent, or be suspended or expelled. Their learning is negatively impacted because of poor concentration, distractibility, inability to retain information, poor peer relationships, and aggressive behavior. They also may be withdrawn and difficult to engage.
- During any given school year, children and youth with mental health disorders may miss as many as 18 to 22 days.1
- The rates of suspension and expulsion of children and youth with mental disorders are three times higher than their peers.2
High School
Youth in high school with mental health disorders are more likely to fail or drop out of school compared to their peers in the general population. They tend to engage in high-risk behaviors including drug and alcohol use and/or suicide attempts, especially those youth who may be significantly depressed because they are shunned or marginalized.
- Up to 14 percent of youth with mental health disorders receive mostly Ds and Fs, compared to 7 percent for all children with disabilities.3
- Youth with untreated mental illness have high rates of absenteeism and tardiness. Referral to a school-based mental health center or to counseling can help to reduce absenteeism rates by 50 percent and tardiness rates by 25 percent.4
- Of students with disabilities in the special education system, those with emotional disorders consistently have the lowest graduation rates and highest dropout rates compared to other disability categories.5 In 2005-2006, 45 percent of students between the ages of 14 and21 that had received special education services for an emotional disorder underIDEA Part B dropped out.6
- Only 32 percent of students with a serious mental illness continue onto postsecondary education.7
Juvenile Justice and Child Welfare Systems
Fifty percent of youth in the child welfare system and approximately 70 percent of youth in the juvenile justice system have a diagnosable mental health disorder, and nearly 30 percent of those in the juvenile justice system experience severe mental health disorders.8 Children and youth with mental health disorders in the child welfare system are:
- less likely to be placed in permanent homes9
- more likely to be placed out-of-home to access services - particularly, youth with internalizing, externalizing, and substance use disorders are more likely to be placed in secure and state-secure facilities than youth without a mental disorder or youth with a different type of disorder 10
- more likely to be placed in restrictive and/or costly services, such as juvenile detention or residential treatment11
- more frequently treated in emergency rooms12
Youth with mental health disorders involved in the child welfare system, like their peers in the juvenile justice system, are also likely to:
- be disproportionately members of racially/ethnically marginalized groups
- live at or below the poverty line
- have strained, limited, or no family connections
- have negative educational experiences and outcomes
In addition, young adults leaving the child welfare system experience major mental health challenges, mental disorders, and drug and alcohol dependence at significantly higher rates than the general population.13
Despite these numbers, for most youth, mental health distress is episodic, not permanent. With the developmental changes and challenges that youth face normally, especially in adolescence, many experience transitional phases of mood and behavioral changes. Youth and their families can successfully navigate the challenges that come from experiencing a mental health disorder. Those with more persistent mental health challenges usually do very well with treatment, peer and professional supports and services, and a family and social support network.
Resources
Enhancing Capacity for Trauma-informed Care in Child Welfare: Impact of a Statewide Systems Change Initiative
This journal article discusses and evaluates a Connecticut state-wide systems change initiative that sought to enhance trauma-informed care for youth in the child welfare system. Significant improvements across all domains of child welfare were found, suggesting that the Connecticut CONCEPT initiative may serve as a strong guiding framework for other states seeking to improve access to trauma-informed care within the child welfare system.
Health/Mental Health Organizations
This resource provides contact information, mission, and scope-of-work descriptions for 53 organizations that focus on health and mental health services and practices. A vast majority of the resources listed primarily serve or have departments that specialize in mental health needs and services for children and adolescents.
Mental Health Services for Children Placed in Foster Care: An Overview of Current Challenges
This article presents an overview of mental health functioning and mental health challenges for children placed in foster care. It also outlines a project that created consensus guidelines for practitioners regarding appropriate and comprehensive mental health screening of youth, identification of youth in the system with emotional and behavioral disorders, and access to high quality mental health services.
Screening and Assessing Child Mental Health
This webpage provides access to an abundance of resources on screening approaches for mental health and trauma-related needs of youth in the foster system as well as guidelines for appropriately using an effective trauma screening approach.
Support Services for Youth in Transition: Mental Health
This webpage provides access to resources for youth transitioning from the foster care system and services to support them most effectively. Included are recent research studies and national conferences on the status of mental health issues and supports within the child welfare system, as well as state and local examples of successful services.
References
1 Blackorby & Cameto, 2004
2 Blackorby & Cameto, 2004
3 Blackorby, Cohorst, Garza, & Guzman 2003
4 Gall, Pagano, Desmond, Perrin, & Murphy, 2000
5 U.S. Department of Education, Report to Congress, 2009
6 U.S. Department of Education, Report to Congress, 2011
7 Government Accountability Office, 2008
8 Burns et al., 2004; Skowyra & Cocozza, 2006; Meservey & Skowyra, 2015; Teplin et al., 2013; Development Services Group, Inc., 2017
9 Smithgall, Gladden, Yang, & George, 2005
10 Hurlburt et al., 2004; Kempker, Schmidt, & Espinosa, 2017
11 U.S. House of Representatives, 2004; Pottick, Warner, & Yoder, 2005; Kempker, Schmidt, & Espinosa, 2017
12 U.S. House of Representatives, 2004; Pottick, Warner, & Yoder, 2005; Moore, Stocks, & Owens, 2017
13 Annie E. Casey Foundation, n. d. ; McCann, 2019
