Integrate Substance Use Prevention & Mental Health Services

Introductory Paragraph

A national study shows that one in five Americans has a mental health issue. In this study, young adults between the ages of 18 and 24, indicated that more than 61 percent of respondents who had used opioids not prescribed to them had done so primarily to relieve anxiety and stress. Early identification, screening, accurate diagnosis, and effective treatment of mental health and substance use conditions can alleviate suffering for individuals and their families dealing with behavioral health challenges. Early access and detection of mental health conditions can expedite recovery, enhance educational and employment opportunities, positively impact relationships, and ultimately improve quality of life.

Mandated screenings for physical health concerns are in place for issues such as vision and hearing. Similarly, early detection of mental health and substance use should occur for young people who may be vulnerable to these issues. These screenings should occur as they do for early detection of physical conditions in venues such as schools, primary health care providers, and other community areas. Communities should be given the tools and support necessary to identify signs of mental health or substance use issues at the earliest possible time. This position is endorsed by the American Academy of Pediatrics, specifically for depression in youth over age 12, and the United States Preventive Services Task Force. Early detection and screening will reduce the likelihood and consequences of delaying care.

Resources such as access to comprehensive mental health and substance use evaluations should be available to parents and guardians whenever warning signs are observed. Access to adequate care can reduce barriers to learning and improve educational, behavioral, and health outcomes for our youth. The most effective services promote collaboration among all of the people available to help. Pertinent individuals include families, educators, child welfare caseworkers, health insurers, community mental health providers, and substance use treatment providers. Reducing barriers and creating incentives can improve collaboration across systems and funding sources.

In order to improve mental health detection and treatment outcomes, some barriers need to be addressed. Health disparities such as lack of health insurance, cultural factors that discourage mental health treatment, and socioeconomic status need to be addressed to ensure adequate care to all individuals. Disparities in communities may be a factor in the early diagnosis and treatment of mental health conditions and can increase mental illness challenges in already vulnerable and underserved individuals, families, and communities.

Key Information

Mental Health and Drug Addiction

Mental health and drug addiction are undeniably linked. According to the National Institute on Drug Abuse “Many individuals who develop substance use disorders (SUD) are also diagnosed with mental disorders, and vice versa. Multiple national population surveys have found that about half of those who experience a mental illness during their lives will also experience a substance use disorder and vice versa.” Studies have shown that around 1 in 4 individuals that have a serious mental illness also have a substance abuse disorder. Many people attempt to use drugs to self-medicate their mental illness or escape their situation, so understanding mental health is essential to any prevention or recovery effort. The National Alliance of Mental Illness (NAMI) has distilled the following statistics from SAMHSA and CDC-

• 1 out of 5 U.S. adults experience mental illness each year
• 1 out of 20 U.S. adults experience serious mental illness each year
• 1 out of 6 U.S. youth, aged 6-17, experience a mental health disorder each year
• 50%of all lifetime mental illness begins by age 14, and 75% by age 24
• Suicide is the 2nd leading cause of death among people aged 10-14

Youth Are Struggling with Mental Health Issues

A nationwide U.S. survey of over 1,300 14 to 22-year-olds conducted in February and March of 2018 shows evidence of a growing mental health crisis affecting young people. The survey, sponsored by Hopelab and Well Being Trust (WBT), found that many teens and young adults who were experiencing moderate to severe symptoms of depression utilized online resources for help. Common uses of the Internet included researching mental health issues online (90 percent), accessing other people’s health stories through blogs, podcasts, and videos (75 percent), using mobile apps related to well-being (38 percent), and connecting with health providers through digital tools such as texting and video chat (32 percent).

Co-Occurring Disorders

Co-occurring disorders, or dual diagnosis, refers to having a simultaneous mental health disorder and substance use disorder. It is common for people with addictions to also suffer from depression, anxiety, or more severe mental illnesses such as schizophrenia or bipolar disorder. Research shows that people who use alcohol or other drugs early in life are more likely to have mental or emotional problems. It’s also true that many people with mental illnesses “self-medicate” with alcohol or other drugs to numb emotional pain, relieve anxiety, or quiet their thoughts. In the past, the medical profession treated one disorder first, typically the substance use disorder, before addressing the other. It is now understood that treating both simultaneously leads to better outcomes. Any successful addiction treatment program will include a mental health assessment and treat co-occurring disorders at the same time.

Depression

• Because depression is under-diagnosed and untreated, depression and opioid abuse are strongly concurrent.
• People with depression show abnormalities in the body’s release of its own opioid chemicals
• Depression tends to exacerbate pain—it makes chronic pain last longer and hurts the recovery process after surgery
• Depression nearly doubles the risk that someone already using opioids will continue to use them long-term
• Depressed people are about twice as likely as non-depressed people to misuse their painkillers for non-pain symptoms
• Depressed individuals were between two and three times more likely to ramp up their own doses of painkillers
• Adolescents with depression are also more likely to use prescription painkillers for non-medical reasons and to become addicted
• Depressed people are likely to keep using opioids, even when their pain has subsided and when they are more functional

Stigma & Depression

Stigmatization of depression can reduce the likelihood of people reaching out to get the mental care they need. Instead, depressed people may ask for prescriptions to treat physical ailments, and use these prescription drugs to treat their emotional pain.

Rural Areas

In particular, shortages of mental-health providers are prominent in rural areas where the opioid epidemic hit the hardest. Some have suggested that providing mental health care to those suffering from chronic pain may help detangle the relationship between pain and depression. Overall, improving detection and treatment of mental health conditions includes improved early screening, assessment, and access to treatment as well as outreach and education in communities.

Relevant Research

Prevention and Early Intervention in Youth Mental Health. This article addresses research associated with moving prevention of mental health from a secondary prevention approach (early intervention) to a series of primary prevention strategies that provide the promotion of mental health for all youth, thus reducing the onset of mental illness. "Evidence suggests that it would be unrealistic to consider promotion and prevention in mental health responsibility of mental health professionals alone. Integrated and multidisciplinary services are needed," calling for broader community engagement that is guided by mental health professionals.

Findings of the Early Detection and Intervention Center Dresden. This article summarizes research that sampled adolescents and young adults who sought help for bipolar disorders. The intervention and treatment recommendations provide insight into the complexity of prevention and intervention in one specific mental illness context, thus, facilitating an understanding of the challenges associated with prevention of co-occurring disorders.

Impactful Federal, State, and Local Policies

SAMSHA Infant & Early Childhood Mental Health Grants are authorized under the 21st Century Cures Act. The purpose of this program is to improve outcomes for children, from birth up to 12 years of age, by developing, maintaining, or enhancing infant and early childhood mental health promotion, intervention, and treatment services.

Project AWARE (Advancing Wellness and Resiliency in Education) SAMHSA also provides State Education Agency grants to develop sustainable infrastructure for school-based mental health programs and services and to ensure that school-aged youth have access and are connected to appropriate and effective behavioral health services. With this program, SAMHSA aims to promote the healthy social and emotional development of school-aged youth and prevent youth violence in school settings. Through Project AWARE, schools are implementing evidence-based, culturally appropriate prevention programs that support youth at the universal, selective, and indicated levels.

Medicaid -- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). This document assists states in the design of benefits that will meet the needs of youth with SUD. It helps states comply with their obligations under Medicaid’s EPSDT requirements. The services described in this document are designed to enable youth to address their substance use disorders, to receive treatment and continuing care and to participate in recovery services and supports. NAMI provides guidance on advocacy for mental health screening associated with the EPSDT program.

HRSA Pediatric Mental Health Access The purpose of this program is to promote behavioral health integration into pediatric primary care by supporting pediatric mental health care tele-health access programs.

Available Tools and Resources

The National Institute of Mental Health
Provides resources on how to find immediate help, health care providers, how to decide if a provider is right for you, how to join a study, and resources to learn more about mental disorders.

The American Academy of Child and Adolescent Psychiatry
Provides a service that helps find child and adolescent psychiatrists throughout America.

SAMHSA Resources for Suicide and Substance Use Prevention in Youth
2017 SAMHSA Webinar on Suicide and Substance Abuse among Young People and includes best practices for prevention and intervention.

SAFE Project Wiki Site Trauma informed Care

Mental Health America MHA's work is driven by its commitment to promote mental health as a critical part of overall wellness, including prevention services for all; early identification and intervention for those at risk; integrated care, services, and supports for those who need them; with recovery as the goal.

National Alliance on Mental Illness NAMI provides advocacy, education, support and public awareness so that all individuals and families affected by mental illness can build better lives. NAMI provides a website, Mental Health by the Numbers," that provides statistics that can be used to promote mental health awareness.

Early Mental Health Screening and Intervention. This clinical practice brief by the American Mental Health Counselors Association (AMHCA) provides information on intervention and screening across the lifespan.

Identifying Mental Health and Substance Use Problems of Children and Adolescents: A Guide for Child-Serving Organizations This manual offers guidance and tools for identifying mental illness or substance use issues early in children and adolescents in various setting, such as in schools, the juvenile justice and child welfare systems, and when receiving primary care.

Promising Practices

Virtual Reality Medical Center (VRMC) has been working since the 1990s to use virtual reality to treat mental illness. An early clinical trial of the software found that after an average of seven sessions, 45 percent of those treated no longer screened positive for PTSD and 62 percent had reliably improved. VRMC uses simulation technologies for:

• Treating patients with anxiety disorders
• Training for both military and civilian populations
• Enhancing various educational programs
• Desensitization
• Sessions at home
• Reduction of the number of sessions people need

M3 Information provides a mental health screening tool that measures outcomes based on a 27-question diagnostic checklist targeted for adults aged 18 and older. The M3 Checklist accurately measures outcomes based on question responses for major depression, bipolar disorder, anxiety disorder and post-traumatic stress disorder (PTSD).

Communities that Care promotes a range of youth mental and behavioral health outcomes, including survey tools, a parenting program, and a variety of prevention education programs.

MyStrength is a digital platform that integrates state-of-the-art technologies to support people in addressing mental and behavioral health issues. It can be integrated with a professional practice to allow them to see more patients more efficiently and better meet the needs of their patients between in-person visits.