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Smiling college students

Redefining how we support mental health in Central Texas

Guest Author: Deborah Cohen, Ph.D.

As a child of the 1980s and 1990s, I was among the first wave of Millennials raised to be overachievers and to expect adult life would go exactly how I had planned. This was not the case. Within months of completing my undergraduate degree, all my plans for post-graduation had fallen through and I found myself living with my parents, unemployed, and with no concrete plans for a path forward.

After a summer of dead-end interviews, in various cities that I desired to live, I accepted a local position as a case manager for adults with a serious mental illness. Looking back on my first full-time job experience, I was woefully naïve, but the experience propelled my career trajectory, and introduced me to important challenges I would not otherwise have encountered.

While I worked with adults of all ages, I naturally connected with my clients who were also young adults. Even though my life looked different from them on the outside, we were experiencing all of the same young adult experiences. We were interested in living independently, being financially stable, having positive adult relationships, and having a job that we enjoyed.

The problem was that the services I was directed to provide were out of step with the needs and interests of these young adults.  I was encouraged to introduce them to the local clubhouse that was filled with aging, incredibly disabled adults and enroll them in Social Security Insurance, even though they continually told me they wanted me to help them get a job.

I quickly learned our community mental health system was not created to meet the needs of young adults. It was created in the 1960s to serve institutionalized adults and had not been modernized to meet the needs of today’s young adults, newly diagnosed with a serious mental illness.

And yet, a healthy transition from adolescence to young adulthood is critical for life success. During this age, people establish lifelong career and relationship trajectories that foster independence. Failure to successfully navigate this transition creates barriers to leaving poverty or initiates a spiral into poverty. It is during these years that most major mental disorders and substance abuse first emerge, disrupting this critical developmental period. Unfortunately, a major challenge facing the U.S. health care system is the lack of mental health services that bridge this age transition.

The most common mental health conditions affecting young people are mood and anxiety disorders. Unfortunately, few programs exist to manage these illnesses, even though rates of depression and anxiety double between the ages of 13 and 18 years; fewer than 40 percent of transition-age youth with depression receive treatment. Although bipolar disorder typically begins in this age range, it is not correctly recognized for up to 10 years after onset despite multiple clinical encounters. African American youth with mood disorders are misdiagnosed with schizophrenia 9 times more often than white teens, leading to significant treatment and outcome inequities. Further impeding progress is that research advances in mental health take up to 20 years to be implemented in ‘real-life’ care.

After more than 10 years, my early work experience has pushed me to change our current community mental health system to better meet the needs of young adults. Through a partnership of a number of similarly compelled colleagues, we have established the Center for Youth Mental Health housed within the University of Texas at Austin Dell Medical School Department of Psychiatry. The goal of the Center is to implement, evaluate and research new ideas that support transition-age youth with a mental illness to become healthy, productive independent adults.

We are doing this by deploying rapid-cycle pilots and new approaches for managing mood disorders in this population that spans the entire course of treatment, from improving diagnostic processes to establishing proof points for effective interventions, to optimizing patient engagement and supporting school and job performance. We work closely with community partners to focus on outcomes that matter, namely keeping transition age youth in treatment, in school, and in jobs.

If we are successful, there is a potential to reformulate community mental health while simultaneously improving the long-term education and employment outcomes for young adults with an emerging serious mental illness. Working hand in hand with the community we serve, we are excited to see what we’re able to achieve.