1. Our Children: Early Identification of Mental Health Issues Ushimbra Buford, M.D. Stop The Stigma: A Mental Health Summit May 2, 2015

2. Framework Stigma, as a barrier to mental heath care, is recognized and continues to be a major factor in identification and treatment Various types of stigma exist and can create very different types of mental health outcomes Individuals are affected by perceived discrimination, which leads to greater internalized stigma Stigma is a global phenomenon with mental health services/training being severely underdeveloped in many developing countries

3. Other Factors Ethnic differences with regard to trust of mental health providers The detrimental effects of stigma is increased by poverty, cultural beliefs and previous experiences with the health care system Media plays a huge part in the belief structure surrounding mental illness

4. Resulting Practices Some parents feel a greater barrier to accessing mental health care secondary to socioeconomic and stigma-related issues Internalized stigma can lead to lower self-esteem and higher symptom severity People who could benefit the most are the less likely to seek out, or be exposed to, critical services

5. Culture of Honor ‘Honor’ states (U.S. south/west) have widespread stigma (self, family, institution) Honor states in the US invest less in mental health Have a lower ratio of mental health practitioners to PCPs Have a lower percentage of state budget devoted to mental health services

6. Early Identification 10-20% of children have a DSM mental illness 25-30% receive services that need them ¾ of all the cases present by age 24; ½ of all cases by age 14 9 years is the average time from 1 st signs/symptoms and receiving treatment (2 years for psychotic illness)

7. Early Identification/Barriers Research suggests that at-risk children can be identified early 80,000 public schools in the U.S.; less than 10% have comprehensive mental health services 2-4x higher rates of mental illness in incarcerated youth vs. general population

8. Early Identification/Benefits Can prevent high-risk problems like suicide, substance abuse, youth violence and accidents The protective effects of mental health treatment include more positive self-appraisal, better societal integration, and better quality of life Overall effectiveness, of mental health treatment, is greater for younger children than adolescents

9. At What Price? Diverting one child from a negative outcome can save society ~2 million dollars over the lifetime Prevention strategies -Universal -Selective -Indicated

10. So What Happens? 1/3 of global burden of disease for adolescents is accounted for by mental illness Mental health disorders are the leading cause of disability- adjusted life years (DALYs) from all non-communicable diseases The burden of stigma raises significant barriers to pursuit of vocational, housing, personal and healthcare goals

11. Real World Limitations Reduced access to mental health providers Shortage of mental health providers/insufficient reimbursement- only 7,000 child psychiatrists in the US Difficulty in performing research because of participant stigma and societal stigma

12. Maladaptive Behavior As high as 70% of incarcerated youth have at least one DSM dx 1/3 of incarcerated males receive help who require it 1/4 of incarcerated females receive help who require it Untreated ADHD may increase the prevalence of psychiatric disorders, substance use disorders, criminality and personality disorders

13. Unintended Consequences Untreated mental illness leads to lower SES, lower quality of life, higher costs to society Less engagement and utilization of medical/dental services Increased provider frustration and decreased provider empathy

14. Solutions Education of the public is, and should remain, a main component of the strategy Decreasing institutional bias/separation between mental illness and medical illness Media portrayals- more positive images, more realistic stories

15. Solutions Strengthening protective factors High maternal & child self-esteem Good maternal emotional health Adequate social support, good academic performance, adequate quality parenting

16. Solutions Integrated health care system (school, clinic)- MCPAP model, headspace programs TeleHealth for underserved areas Increasing funding for community-based activities/resources

17. Thank You