By Sarah Samuelson and J. Wesley Boyd
Transition-age youth (age 18-25) are at high risk for mental health, physical health, and substance use problems, yet they are falling through the cracks due to the lack of services aimed directly at this vulnerable population.
We are mental health clinicians who have seen young people in various mental health settings, and we have seen firsthand the myriad of medical and substance abuse problems these youths can face.
First, many psychiatric illnesses initially show themselves during this stage of life, including mood disorders such as depression and bipolar illness. This period is also marked by an increase in the prevalence of schizophrenia. Despite the high risk of these disorders arising, existing research indicates that transition-age youth with mental disorders are less likely to receive mental health services than individuals in both younger and older age groups. For example, mental health service utilization among individuals aged 18-19 has been found to be about half the rate of individuals aged 16-17, with rates of utilization continuing to be low throughout the remainder of the transition-age period.
The transition-age period is also a peak time for alcohol and drug use, and the period when the development of problematic substance use is most likely to occur. The risk of substance use disorder is even higher for transition-age youth with serious mental illness, such as major depression. In fact, the co-occurrence of substance use disorders and serious mental health conditions is concentrated in the transition-age period relative to other developmental periods. And when substance use disorders and mental health conditions co-occur, long-term negative consequences and functional impairment are worse than for those who have one disorder alone.
To compound matters, psychiatric illness, substance use disorders and medical illness go hand in hand and, in fact, feed off one another. For example, chronic medical illness is associated with a high prevalence of major depression. Individuals with depression have been found to die prematurely due to medical illnesses, in the range of 5-10 years earlier than those without depression. The range of health conditions associated with drug and alcohol use are vast and include hypertension, HIV, cardiovascular disease, and chronic liver disease.
So with all of these dangers lurking for youths who are in this transition age, are they getting the care they need? Sadly, the answer is no, not even close.
Why not? Substantial gaps in mental health and medical care can occur as individuals shift from child to adult health care providers during this time. There is evidence of decreased mental health and medical care utilization during the transition-age period. We can begin to understand this phenomenon by recognizing that the transition-age period can be viewed as a “perfect storm” given the number of reasons that interruption of care is likely. These include changes in providers, increase in substance use, financial stressors, uncertainty regarding health insurance, changes in diet after leaving home, changes in physical activity, and importantly, inadequate attention to the importance of developing services that are tailored to the unique needs of this population.
In the midst of an opioid epidemic, the fact that transition-age youth are not sufficiently receiving needed services is a travesty. In the current political context, where substantial efforts have been made to strip individuals of health insurance, this is particularly troubling. Studies have shown that even those with insurance who do try to access mental health care face long odds of success given the large numbers of practices that are full or that don’t take insurance.
Given these realities, not only do we need to ensure that these individuals have health insurance, but we need to have mental health and medical services that are specifically geared toward this transition-age population. We need to have good handoffs when youth are leaving pediatricians and transitioning to adult services. Clinics and services should be specifically tailored for this community.
Implementing these changes will not only help improve the health and well-being of our youths in the moment, but it will also likely improve numerous lives for decades to come.
Sarah Samuelson M.A, M.S. is a clinical psychology pre-doctoral intern at Cambridge Health Alliance/Harvard Medical School.
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