Need for Advocacy for Adolescents with Mental Illness
the fact that mental illness is one of the top five causes of morbidity,
mortality, and disability for adolescents, those suffering from mental illness
continue to go without the treatment they so desperately need (Dolan, Fine,
& The Committee On Pediatric Emergency Medicine, 2011). Adolescents have
special needs that are specific to their age group that are not easily
understood by the general public. In addition to that there is a lack of
recognition of adolescent mental health needs that leads to under
identification (Jenson et al., 2011). Because adolescents do not have a voice
and are dependent on others for their care, it is vital that they have an
advocate (Hohenhaus, 2005). A mental health advocate can be the bridge over the
mental health care gap so many adolescents fall into.
Overview of Adolescent Mental Illness
order to understand why having an advocate is necessary, it is important to
understand the prevalence and complex needs of adolescents with mental illness.
In adolescence neural pathways and behavioral patterns are created that will
last throughout their lifetime (Adolescence is a transitional time when new
attitudes, issues, and behaviors are explored (Martin, 2014). While this
exploration is necessary, it also a stressful time for adolescents.
(2014) cites abstract reasoning as the primary issue that complicates the
mental health treatment of adolescents. Being able to think abstractly is a
necessary step towards becoming an adult but adolescents do not yet have the maturity
to either ask the right questions, or misuse the existence of grey areas to
support negative thoughts and behaviors. While this time period is one of
exploration and sorting out how they feel and believe about the world around
them, for an adolescent with mental health issues, this can create serious
problems (Martin, 2014).
Fine, and The Committee on Pediatric Emergency Medicine (2011) report that
twenty one percent of children in between the ages of 9-17 have a diagnosable
mental illness or substance disorder and that ten percent of children in the
United States currently suffer from mental illness. Sadly, Only a third of those adolescents who
are identified to have mental illness receive treatment (Merikangas et al.,
2011, abstract). Adolescents who suffered with attention deficit/hyperactivity
disorder (ADHD) and those who have more severe forms of mental illness are more
likely to receive treatment than those with milder forms of mental illness or
those with “anxiety, eating, or substance abuse disorders” (Merikangas, et al.,
suicide is the forth-leading cause of death for 10-14 year olds with more than
half of adolescents overall experiencing suicidal thoughts (Dolan, Fine, &
The Committee on Pediatric Emergency Medicine, 2011). It must be noted that
were early screening tools used and proper treatment available, suicide would
not so frequently be the outcome. If only a third of adolescents are getting
treatment, two thirds are left suffering alone.
is clearly a gap between the needs of adolescents suffering from mental illness
and the treatment options available. Living with mental illness is possible;
adolescents just need assistance learning how to live and the tools necessary
to navigate their illness. Advocacy is the key to bridging that gap so that
adolescents can reach a place of health and wholeness.
What Does an Advocate Look Like?
advocate can be a parent, concerned family member or other adult, educational
or medical providers, or others within a community who see a need and want to
find ways to meet that need (NAMI, 2015). While training could be vital in
preparing an advocate for the task at hand, the most important feature of an
advocate is the desire to help those who are suffering overcome the barriers to
treatment. A passion for change is necessary when dealing with such a
fragmented and broken system. Advocating for adolescents with mental illness is
no easy task and will require creativity, tenacity, and concern. Advocacy is a
world in which it is easy to get discouraged, but the payoffs are tremendous
for both the advocate and those they help.
of now, there are not any nationally recognized standards or ways a person can
become an advocate (Torrey, 2011). Because there are not any nationally
recognized standards as with other professions and roles, becoming an advocate
varies greatly on the type of organization and setting a person chooses to
advocate. There is currently an effort by the Alliance of Professional Health
Advocates (APHA) and others to develop a nationally recognized program for
advocacy certification (Torrey, 2013). This program is just in the beginning
phase though it is a step in the right direction for establishing national
credentials for advocates. Until such time as a national program is developed,
those interested in advocacy have to research local resources to advocate and
participate in whatever training that specific agency requires. For example,
the National Alliance on Mental Illness [NAMI] offers training and resources on
advocacy for those with mental illness. Advocates in the NAMI organization can
be involved in multiple types of advocacy projects from individual advocacy to
political action to help make changes on a national level (NAMI, 2015)
Barriers to Effective Treatment and
are many barriers to the effective treatment of adolescents with mental
illness. Mental illness generally has negative connotations that lead to
negative attitudes and beliefs about the person who is suffering. The greatest
barrier appears to be the stigma associated with having mental illness as it
prevents adolescents or their families from seeking treatment in the first
place (Cowan, 2014).
Evans-Lacko, and Thornicroft (2013) report that over seventy percent of those
with mental illness do not pursue adequate treatment due to the fear of being
discriminated against. Being afraid of stigma is a very real fear as three out
of four people with mental illness experience stigma (Government Of Western
Australia Mental Health Commission [GWAMHC] (2010).
already struggling with their identity and issues such as depression and
anxiety could easily be overwhelmed the discrimination associated with being
labeled mentally ill. Unlike physical illnesses, those who suffer from mental
illness are seen as less socially desirable and have difficulty in
relationships, educational and job settings, and the community at large (Henderson
et al., 2013). It is easily understood why an adolescent would choose to suffer
in silence rather than add the weight of stigmatization as well.
not only affects the initial decision to pursue treatment, but also at
institutional and community levels (Henderson, Evans-Lacko, & Thornicroft,
2013). Those with mental illness are generally socially outcast and therefore
not involved in the decision making process for policies and procedures that
inevitably affect them. This group of adolescents is either without a voice, or
their voice is dismissed due to the belief that because they have mental
illness they are incapable of being a productive member of society (GWAMHC,
2010). Stigma also leads to a lack of support for the family as they are viewed
with suspicion and malice. Those who are stigmatized have “experiences and
feelings of shame, blame, hopelessness, and distress” (GWAMHC, 2010).
barrier to treatment is skepticism as it leads people to reject those things
they do not understand (Cowan, 2014). The behaviors exhibited by the mentally
ill are oftentimes seen as attention seeking rather than the presentation of
mental illness. This is further complicated by a general lack of understand
about what mental illness looks like in adolescents as well as how the treatment
for adolescents is different.
(2014) reports that adolescents are oftentimes seen as unruly and rebellious
and while this is at times true, symptoms of mental illness could be mistaken
for rebellion causing the adolescent to be denied care. People do not see the
suffering of having a mental illness as a real problem so they don’t take
adolescent who seek help seriously (Cowan, 2014).
Christian community is notorious for ignoring the importance of mental health
issues and even persecuting those with mental illness. Menzie (2014) reports
that rather than understanding that they live in a fallen world where illness
exists, they attribute mental illness to a lack of faith, the result of sin, or
spiritual attacks. This is sadly
supported by many scriptures such as Philippians 4:6 that says, “Do not be
anxious about anything” or Romans 12:12 which says, “Rejoice in hope, be
patient in tribulation, be in constant prayer” (New International Version). The
misguided translation is that is they will just trust God or just pray those
with mental illness will be fine. What they fail to recognize is that Jesus
himself experienced every human emotion. When people talk about Jesus they
forget about the Jesus who overturned tables in anger, lonely Jesus who begged
for His disciples to stay up with Him while He prayed, or even desperate Jesus
who asked why God had forsaken Him. Having emotions or distressing thoughts,
even overpowering emotions and thoughts are no more sin than having a cold.
Overcoming stigma and skepticism.
Knowledge is power and in no other circumstance is that true. Hohenhaus (2005)
reports that educating others about adolescent mental illness and how it
affects the adolescent, their family, the community, and society at large is
the most important thing an advocate can do. As adolescents, their caregivers,
and others receive training in mental health related issues, a veil is lifted
making it less likely for symptoms to be seen in a negative fashion and or
the Christian community advocates can educate members about the causes and
symptoms of mental illness while pointing to scriptures that point to
compassion, advocacy, and hope. Jesus came to heal the broken hearted, to
comfort them, to shine a light into their darkness.
student posits that advocates can hold classes or trainings in the community to
help members understand what mental illness is, what it looks like, and how it
can be treated. Churches, schools, and mental health centers would be excellent
locations to hold such classes. The Internet is also a very effective tool at
reaching the masses. An advocate could create informational websites with links
to resources important in in mental illness. Websites could also include
message boards so that adolescents or their families could communicate with
people who have similar experiences though this student recommends such a
website be heavily monitored to prevent exploitation or bullying.
of Organization, Effective Screening, and Quality Measures
a parent or caregiver recognizes the need for treatment, they are likely to
find an inadequate system that is difficult to navigate and seemingly
impossible to find hope in. Mental health treatment has been absent from most
organized efforts to improve and measure the quality of care (Pincus,
Spaeth-Rublee, & Watkins, 2011). This lack of organization and
accountability leads to system devoid of effectiveness.
Fine, and The Committee On Pediatric Emergency Medicine (2011) cite an
inadequate or non-existent screening process that is caused by a lack of
education and training. There does not appear to be a set standard in how to
screen for, identify, or treat those adolescents with mental illness. For the
most part the adolescent or their caregiver are at the mercy of whatever
provider they come across and that specific person’s level of understanding and
knowledge as well as their wiliness to get involved. Throughout childhood
children are screened for multiple types of physical illness, it seems to
reason that the implementation of a broad based mental health screening tools
would be a positive step. In fact, according to Berger-Jenkins, McCord,
Gallaher, and Olfson (2012) the providers who implemented a mental health
screening tool in the pediatric office saw that parents were more open to
discussing mental health problems and that attention to mental health problems
by clinicians was increased. Despite this increase in attention, referrals did
not increase so the system was not overburdened (Berger-Jenkins et al., 2012)
American Psychological Association [APA] (n.d.) cites a lack of coordination,
inconsistency in policy and procedures, and a lack of funding as the cause for
the lack of identification of adolescent mental health needs. The mental health
systems fragmentation makes continuity of care borderline impossible resulting
in many adolescents suffering needlessly.
Overcoming the lack of organization, effective screening,
and quality measures.
In 2010 the U.S Department of Health and Human
Services (HHS) was tasked with the development of a National Quality Strategy
(NQS) by the Patient Protection and Affordable Care Act (ACA). The ACA’s purpose
was to assist people in finding affordable, safe, and effective healthcare (Substance
Abuse And Mental Health Services Administration [SAMHSA], 2014). While the ACA
was a step in the right direction, and included stipulations for behavioral and
mental health, its implementation in the mental health field has been sporadic
at best (Pincus, Spaeth-Rublee, & Watkins, 2011).
the unique needs that mental heal encompasses, the SAMHSA (2014) used the NQS
to create a framework for measuring the effectiveness of treatment and
treatment outcome measures within the mental health field called the National
Behavioral Health Quality Framework (NBHQF). The goal of the NBHQF is to provide
“a mechanism to examine and prioritize quality prevention, treatment, and
recovery elements at the payer/system/plan, provider/practitioner, and
patient/population levels” (SAMHSA, 2014).
wishing to become involved in changing the mental health system so that the
needs of adolescents are met could become involved with the implementation of
the standards laid out in the NBHQF through working directly with agencies or
their governing authorities. According to the SAMHSA (2014) there is not a
cohesive method for measuring treatment outcomes. Advocates could help in the
creation of outcome measures to determine the effectiveness of various forms of
treatment or even to examine the provider performance. Now is a great
opportunity to become involved in an up and coming field that is much needed
and long awaited.
of Training and Time
mental health system is overwhelmed in general making it even less likely to be
able to handle the specific needs of any one group, especially one that does
not have a voice such as the adolescent (Hohenhaus, 2005). There are simply not
enough people educated in adolescent mental illness to identify or treat those
who are in need of help. Sadly many professionals and community members do not
even recognize the need for specialized training. Most people consider
adolescents to be “little adults” rather than recognizing they have unique
needs (Hohenhaus, 2005).
when a provider recognizes the need, the limited amount of professionals to
support them leaves them overburdened.
There are simply too many adolescents with too many needs and everyone
suffers. Providers are left without the time necessary to effectively intervene;
this is true of teachers, counselors, medical providers, and other concerned
community members (Hohenhaus, 2005).
Overcoming the lack of training and
Dolan, Fine, and The Committee on Pediatric Emergency medicine (2011)
advocate for the training of social workers, physicians, and community mental
health workers in the intricacies of treating adolescents with mental illness.
Training should start first with how to identify those who have unmet mental
health needs, according to Jensen et al. (2011) this is best accomplished by
developing a brief and easily understood method with scientifically designed
warning signs. Providers should be trained in use of such a screening tool so
they are better able to utilize their time. Currently mental health issues are
generally dealt with on a crisis basis, which takes significantly more time and
energy for all involved. Having an organized method for identifying problems
before they turn into a crisis will lesson time providers are stuck dealing
with a crisis.
with mental illness and their families are currently suffering needlessly due
to a fragmented and inadequate system. The treatment of mental illness involves
a multi-systemic approach but at this time, there is no central piece
coordinating treatment so that there is continuity of care. A mental health
advocate can be the difference between wellness and another child being lost
forever to suicide or other serious mental illness. The mental health advocate
can collaborate with the adolescent, their caregivers, teachers, doctors,
therapists, and others in the community to ensure that their needs are met in a
way that facilitates healing and growth. The system is overburdened dealing
with the crisis situations caused by adolescent mental illness. As advocates
become more involved crisis can be circumvented and lesson that burden.
Psychological Association. (n.d.). Improving quality and coordination of child
and adolescent mental health services [Web log message]. Retrieved from
K. (2014). A journal through the labyrinth of mental illness. Phi Delta
(4), 14-18. Retrieved from
M. A., Fine, J. A., & The Committee On Pediatric Emergency Medicine.
(2011). Technical report: Pediatric and adolescent mental health emergencies in
the emergency medical services system. American Academy of Pediatrics, 127
e1356-e1366. Retrieved from
S. (2005). Policy advocacy for children. Journal of Emergency Nursing, 31
P. S., Goldman, E., Offord, D., Costello, E. J., Friedman, R., Huff,
B.,...Roberts, R. (2011). Overlooked and underserved: "action signs"
for identifying children with unmet mental health needs. Pediatrics, 128
M. (2014). Introduction to human services: Through the eyes of practice
(3rd ed.). Upper Saddle River, NJ: Pearson.
K. R., He, J. P., Burstein, M., Swendsen, J., Avenevoli, S., Case, B., &
Olfson, M. (2011). Service utilization for lifetime mental disorders in US
adolescents: Results of the National Comorbidity Survey-Adolescent Supplement
(NCS-A) [Abstract]. Journal of the American Academy of Child &
Adolescent Psychiatry, 50
(1), 32-45. doi:10.1016/j.jaac.2010.10.006
H. A., Spaeth-Rublee, B., & Watkins, K. E. (2011). The case for measuring
quality in mental health and substance abuse care. Health Affairs, 30
M. D., Logsdon, M. C., & Myers, J. A. (2011). Feasibility, acceptability,
and initial efficacy of a knowledge-contract program to reduce mental illness
stigma and improve mental health literacy in adolescents. Social Science
& Medicine, 72
(12), 1-2019. doi:10.1016/j.socscimed.2011.04.006
M., Cobham, V., McDermott, B., & Murray, J. (2013). Youth mental illness
and the family: Parents' loss and grief. Journal of Child and Family
, 719-736. doi:10.1007/s10826-012-9625-x
J. (2012). Bridges not walls: A book about interpersonal communication
(11th ed.). New York, NY: McGraw Hill.
T. (2011, January 3). The myth of patient advocacy certification [Web log
message]. Retrieved from
T. (2013, March 1). Is patient advocacy certification on the horizon? [Web log
message]. Retrieved from