Throughout middle and high school, I knew plenty of people in need of mental health services. But in little old Anderson, TX with a population of 200, going to therapy meant going to town—and driving anywhere between 20 and 40 miles to get there.
So when I noticed patterns in who received treatment and who didn’t—that my friends with ADD saw a psychiatrist every month but my friend who harmed hadn’t even seen her general practitioner—I thought that it was the sad reality of living in a rural area. I thought it had to do with the “haves” and “have nots,” not in sense of being rich or poor, but in the sense that some parents could afford to take off work and drive their kids to town, and others barely had enough gas to make it to work in the first place.
But a study conducted by National Institute of Mental Health reveals that there are, in fact, patterns as to which types of disorders are more likely to be treated in youth. On average, the rate of treatment for youth with ANY disorder is 36%, but some disorders are treated at twice this rate—and some, at half.
If you think about it, it makes sense that certain disorders tend to get treated when others don’t. Surely, a visible disorder that causes physical harm to the body—like anorexia, or when an individual self-harms—would have a higher treatment rate than a less visible condition, like unipolar depression. We’d also expect that the more debilitating the disorder, the higher the treatment rate.
This explanation, however, couldn’t be farther from the truth.
The highest rate of treatment goes to ADHD, of which 60% of cases receive some sort of treatment. This is followed by behavior disorders (characterized by patterns of disobedience, aggressiveness, or hostility) at 45%. Mood disorders like bipolar and unipolar depression—in which you often find self-injurious behaviors—have a treatment rate of only 38%.
The most surprising—and haunting—statistic lies at the end. Two of the disorders that are the most harmful to our bodies—two disorders that can actually lead to non-suicidal death—have the lowest rate of treatment of any disorder: substance abuse, at 15%, and eating disorders, at 13%.
We are talking about youth ages 13 to 18. These are the ages where we get our first jobs, meet our first loves, breathe in the first fresh breath of independence. We’re fighting for an identity and, along the way, we often convince ourselves that we are adults. But teenagers are not adults.
Teens often lack the resources and know-how to seek out their own mental health treatment. Sometimes, they turn to friends or social media for advice, but if a teen is going to receive professional help, chances are they have to rely on the adults in their life to make it possible.
So I had to ask myself: if the severity of the disorder doesn’t determine whether or not a teen gets treatment, does it have something to do with their parents, guardians, or even teachers?
In this light, two possibilities—each troubling in and of itself—emerge:
The first is stigma.
And the second—well, the second is that it’s just not the adult’s problem.
Perhaps we’re beginning to realize that mental disorders are, in fact, real conditions that are neither trivial nor the fault of the affected. However, there is still this idea that teenagers act depressed or feign eating disorders for attention.
It may not be explicit attention-seeking, per se, but at the very least these behaviors stem from a desire to “fit in,” “find oneself,” or are a product of their over-dramatic, hormone-driven teenage angst.
In other words, parents or guardians might misinterpret signs of a mental disorder as being nothing more than normal—if frustrating—teenage behavior.
If anything, we’ve turned the moodiness, reclusive behavior, and melodrama that we often associate with teenagers into a stereotype we can laugh at. And, believe me—teenagers are aware of the way the adult world views them.
We cannot joke one day about our teen’s moodiness and expect them to admit to a mood disorder. We cannot laugh about how over-dramatic teens are and expect them to think we’d listen when they talk about suicidal thoughts.
It doesn’t matter that the majority of us believe we would listen and take their problems seriously, because that’s not the message we send our teens.
Add that to stigmas attached to mental illnesses regardless of age, and you’ve got a recipe for never letting a soul know until it’s almost—or it is—too late.
It Doesn’t Affect The Parents
Stigma can’t be the only reason more severe disorders have such low treatment rates. For all the misinformation out there about eating disorders, substance abuse, and mood disorders, at least most people are willing to admit that these disorders exist.
ADHD, on the other hand, is considered to be a convenient diagnosis for parents who are unwilling to deal with their child’s behavior—and yet, it has the highest rate of treatment. If teens feel their parents would dismiss the idea of a mood or eating disorder, why would they think their parents would believe that the fact they don’t pay attention isn’t their fault?
If you think this scenario sounds odd—a 14-year-old coming up to their parents in tears, saying that they think they have ADHD—then you’re on the right track. We have, so far, only considered one of the ways in which parents or guardians become aware of their child’s problems: the child asking for help. In cases where the child doesn’t not ask for help, however, it is up to the adults in a child’s life to recognize troubling behaviors and decide whether or not to act.
Therefore, disorders that negatively affect the adults in the teenager’s life—instead of just the teenager themselves—might have a higher rate of treatment.
Think about it: parents of children with ADHD or behavior disorders have a harder time getting their children to behave or make good grades in school. Handling a hyperactive child requires more effort on the parents’ or teachers’ parts; meeting with teachers and school administrators to address poor academic performance can take up a lot of time.
And youth with behavior disorders are often truant, overly hostile with their parents, and can even get into trouble with the law.
In other words, these disorders disrupt the parents’, guardians’, or teachers’ lives as well as the child’s. The adults in the life of a child with ADHD or behavior disorders also benefit from treatment—and so, perhaps, this is why these disorder get treated.
So Are Caregivers Just Selfish?
It’s easy for me, fresh out of my teenage years, to get angry and jump to the conclusion that adults don’t care about the mental health of their children until the disorder begins to affect them too. But that’s not entirely fair.
The truth is, we don’t like to think of our children as sick. No one wants to entertain the thought that their child thinks about killing themselves, self-injuries, or starves themselves. It’s a hard pill to swallow, and it’s easy to deny the evidence.
We are eager to accept the excuses of “I ate later” or “the cat scratched me” when we see evidence of troubling behaviors. Yes, unacknowledged mood, anxiety, eating, and substance abuse disorders can have less of a daily effect on the parent’s lives and are less treated than those that have a large effect, but that doesn’t necessarily mean that parents think, I know my child is starving herself, but it doesn’t affect me and so I’m not getting her treatment.
Instead, the parent thinks, Oh, my child has lost a ton of weight and rarely eats dinner with us anymore, but that’s probably because they just started basketball practice and she probably eats with her friends afterwards.
Ignorance is bliss, so they say. But not recognizing when our children need help can be devastating for the child—and in some cases, life threatening.
Here’s the unfortunate truth: if a child is suffering from a mental disorder, they are suffering from a mental disorder. Convincing ourselves otherwise doesn’t change that fact; it just causes more damage.
And, as these stats indicate, we have caused a lot of damage.
We are failing our youth.
What Can Be Done About It?
We need to familiarize ourselves with the warning signs of mental distress in our children. NAMI has a list of troubling behavior to be aware of, and the MHA not only tells you what to look out for but also tells you how to proceed if you see any warning signs.
Schools and educators also need get on board. NAMI has great presentations for parents and teachers and for middle and high school students. If you are an educator or you have a kid in school, you can suggest to the administration that NAMI come give one or both of these presentations.
But it’s not enough to know the warning signs—we need to promise ourselves to act if we witness them. If we notice huge weight loss, unusual scars, low mood, a change in grades, or anything troubling, we cannot convince ourselves that it’s not what it seems. We need to open up a conversation with the kid and access the situation. Even if it’s not what we think it is—like when my Spanish teacher expressed concern for my rapid weight loss, which was a result of a physical chronic condition—just showing the teen that we are willing to help might make them more comfortable coming forward if there ever is a problem in the future.
Even before warning signs emerge, we need to show our youth that if they come to an adult asking for help, they won’t be laughed away. This includes not only letting the children in your life know that they can come talk to you about anything, but also making sure that your everyday actions and jokes don’t invalidate their feelings. As I said before: if every time a teen gets frustrated you laugh, what makes you think they’ll expect you to listen when they come to you with a problem much, much bigger?
Our youth are our responsibility, and, with that, the disparities in treatment rates of mental disorders are most certainly our problem. It’s time to take the hands off our ears, and hands off our eyes, and the hands off our mouths—so that we can shout out and say, This is not acceptable. And I will do something to fix it.