Mental Illness Across the Ages

Despite some recent improvements, the chance that children or adults in America will get care for their mental illnesses is still critically low.


Nelson Freimer

While around 42 million adults in the US have a mental illness each year, “less than 40 percent of all adults who have mental illness got any treatment at all last year,” said psychiatrist Nelson Freimer during a panel discussion on mental illness across the lifespan at the American Association for the Advancement of Science (AAAS) in Washington, DC, on Wednesday. Freimer, director of the UCLA Center for Neurobehavioral Genetics, also warns of “an epidemic of depression” among people just entering adulthood now, more than in previous generations.

About half of all lifetime cases of mental illness begin by age 14, said fellow panelist Anne Marie Albano, citing research supported by the National Institute of Mental Health (NIMH), and many receive only short-term care or no care at all.

Anne Marie Albano

“Anxiety disorders in childhood predict every mental illness you can name in adulthood,” said Albano, of Columbia University Medical Center. Children can be diagnosed with anxiety (including phobias) at as young as four years old. Some pediatricians and parents think the child will grow out of it, but “specific phobia is not harmless; social phobias are not harmless. They are not phases: Anxiety disorders are the gateway disorders.” Next come behavioral disorders, around age 5, while mood disorder diagnoses can start when children are around 12, and substance abuse around 16-17. “A lot of times, substance abuse is self-medicating for anxiety disorders,” Albano said.

“Children are suffering, they’re suffering early, and they’re suffering from all the conditions you heard about related to adults.” The good news is that we do have effective treatments, including behavioral therapies and drugs; the bad news is that children often wait a long time for care, if they even get care.

“Most adolescents with mental disorders are never treated,” she said. Only about 36 percent of children with any mental disorder received services; about half of children who were severely impaired by their mental disorder received professional mental health treatment, according to the NIMH study. The majority (68 percent) of the children who did receive services had fewer than six visits with a provider.

For children, delayed or missing treatment can have a lifetime cost. As soon as they develop an illness, they “fall off the developmental track,” Albano said, not learning social problem-solving skills and falling behind academically as the critical years pass. She suggested experimenting with bringing care (counselors and doctors) to “where the children are, in school” to reach more kids sooner.

Colleen Barry

Colleen Barry

“The US healthcare system doesn’t always do a good job of matching mental healthcare services to those in greatest need,” said Colleen Barry of Johns Hopkins Bloomberg School of Public Health. For example, since the late 1990s the number of inpatient psychiatric beds for people in severe need in the US has dropped precipitously. In a recent mental-healthcare census, “the great majority of states reported substantial shortages in hospital beds,” she said.

There is a little good news, though. Public policies like the Mental Health Parity and Addiction Equity Act and the Affordable Care Act have increased access to insurance, reducing the cost of diagnosis and treatment for many people, Barry said. This includes young people just reaching adulthood, who Albano had described as slipping through the cracks as they aged out of their parents’ healthplans.

And while our current treatments (psychotherapy, pharmacotherapy, neuromodulation) are limited, researchers are starting to focus on new targets for treatment, including the similarities among disorders, Freimer said. “These disorders at the genetic level are really quite correlated, we’ve learned in recent large-scale studies. … To get to a solution, we need to study them together.”

A first step to new treatments is identifying genetic variants. “So far, we’ve found 110 different genes correlated for schizophrenia,” he said, which offer many new targets for possible therapies, but the results have not been as good yet for depression. The mood disorder varies so widely among people that some say a study would need more than 100,000 people’s genes to find anything. Freimer and UCLA are starting such a study, called the Depression Grand Challenge.

This event was part of the Neuroscience and Society series, supported by AAAS and the Dana Foundation; full video from the session is below. Previous sessions include The Neuroscience of Infant Development (story, video), Stress and the Brain (storyvideo); and The Science of Sleep (storyvideo). The next session, on creativity, will be on October 27.

– Nicky Penttila

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