Early identification of mental health issues in young people

Early identification, accurate diagnosis and effective treatment of mental health and substance use conditions¹ can alleviate enormous suffering for young people and their families dealing with behavioral health challenges. Providing early care can help young people to more quickly recover and benefit from their education, to develop positive relationships, to gain access to employment, and ultimately to lead more meaningful and productive lives.

MHA believes that early identification of mental health and substance use issues should occur where and when young people are mostly likely to present concerns, such as in school. In addition to schools, primary health care providers should have the training and funding to identify and treat mental health conditions and other community leaders should be given the tools and supports necessary to identify signs of mental health or substance use issues at the earliest possible time.

Community outreach and education are necessary to identify problems to refer youth to additional comprehensive assessment and to the care they need to cope with mental health and substance use challenges. Funding and promotion of community outreach and education to identify early signs of mental health and substance use conditions can arm parents, teachers, friends, spiritual leaders, mentors, and community leaders with knowledge, skills, and resources for identifying and referring youth into necessary care.

Whenever warning signs are observed, resources should be available to parents or guardians to access comprehensive mental health and substance use evaluations and services needed to promote recovery.² Access to adequate care can reduce barriers to learning and improve educational, behavioral and health outcomes for our youth. The best services promote collaboration among all of the people available to help, including families, educators, child welfare case workers, health insurers, and community mental health and substance use treatment providers. Barriers should be reduced and incentives created to ensure increase collaboration across systems and funding sources.

Mental health is shaped by many factors, from genes and brain chemistry to relationships with family and friends and adequate, nutritious food, exercise, and sleep.^3,4 Research shows that early intervention can prevent significant mental health problems from developing.⁵ Epidemiological research confirms the relationship between mental health issues and suicide or self-harm, substance abuse, suspension, dropping out, expulsion and involvement with the juvenile justice system.⁶ The research also shows that effective treatment can reduce the risk of such consequences.⁷

Research provides us with an understanding of the prevalence of mental health and substance use problems among youth. The importance of identifying and targeting problems in young people both before and after adolescence is strengthened by the fact that 50% of mental health problems present themselves by the age of 14.⁸

Similar to other medical conditions, mental health conditions are easier to treat early. Discrimination and shame around these conditions often leads to significant delays between symptoms and treatment. Accordingly, it is very important to intervene as early as possible.

Prior to the COVID-19 pandemic, as many as one in six U.S. children between the ages of 6 and 17 had a mental health disorder. Additional stressors on children and youth related to loss of classroom and social time, among other concerns, have resulted in a surge of behavioral health concerns, with the CDC reporting that in the first six months of the pandemic, mental health-related emergency department visits increased 24 percent for children ages 5 to 11, and 31 percent for those ages 12 to 17.

Mental Health America’s data indicates that these trends of poor mental health are persisting.  Since its launch in 2014, 25.7 million people have taken advantage of MHA’s validated tests for mental health conditions by taking a test online, making this program the nation’s largest ongoing, real-time mental health early identification program. The program has grown exponentially since 2014, from an average of 1 million screens per year to a staggering 6 million a year since 2021.

Some key findings from our research include:

Youth are struggling with their mental health and are seeking support online. 41% of individuals in the U.S. who took a wellness check in 2023 were under 18.
Rates of moderate to severe anxiety began increasing in June 2020 and have remained above pre-COVID-19 levels through December 2023. Of the people who took an anxiety screen in 2023, 78% scored with symptoms of moderate to severe anxiety.

Source: Findings from MHA Wellness Checks [MM1] re: Youth, 2023. (from: MHA Lessons from screening)

In August 2022, CMS released an Informational Bulletin essentially reminding states of their obligation under Early Periodic Screening Diagnosis and Treatment (EPSDT) provisions of the Medicaid Act to provide all medically necessary care, including for the prevention, screening, assessment and treatment of mental health and substance use disorders.[i]  The bulletin notes that early detection of mental health and substance use issues is crucial to the overall health of children and youth, and may reduce or eliminate the effects of a condition if detected and treated early. It encourages states to provide certain medically necessary EPSDT services without requiring a behavioral health diagnosis first. CMS also encourages states to leverage telehealth to increase access to mental health services.

• Federal and state funding is needed for mental health prevention and early identification.  Resources are often only allocated after a child has been identified with a significant need instead of allowing for screening and early intervention.  States should consider policies that provide screening, free visits, peer support, and treatment without the requirement for a formal diagnosis. State and federal funding should be directed to providing integrated services where children are – in schools and primary care.
• EPSDT compliance, i.e. state rates of screening and referral, are reported to CMS and publicly available but are difficult to interpret and compare.¹⁰ Reporting of depression screens along with lead levels would be helpful given large numbers of children affected by these conditions and the required reporting for the Medicaid Core Data set. The federal government should monitor state performance on Core Medicaid Children’s Set with respect to behavioral health screening and treatment and should take action to ensure compliance with EPSDT. Consent decrees have been entered against several states that were not meeting their EPSDT obligations.¹¹
• As part of the Every Student Succeeds Act implementation, school districts should identify current programming that supports identification and treatment for mental health and coordinate and augment these efforts to ensure that they fully meet the social and emotional needs of the students, as revealed by the district’s needs assessment. Getting and protecting required funding for screening and treatment is essential as schools face cutbacks.
• State and federal funding should facilitate the process of health centers opening branch sites as school health clinics  to supplement the school-based health center movement.  All school health centers should have sufficient funding and be required to offer mental health and addiction screening and services.
• Additional federal and state funding can support research and implementation of community based education on early warning signs and early brief strategies for prevention and early intervention.  Federal and state governments can also provide more funding and direction to expand health education in schools to include mental health education and actionable steps to improve mental health through sleep, exercise, social media use, and other actions.
• The federal government and states should develop the workforce that will promote prevention and early intervention, such as peer support specialists, community health workers, and behavioral health providers in primary care.