What do I do if I get a positive result from a teen mental health screening? It’s a question I get from my primary care colleagues when discussing the important role that we can play in reducing the impact of adolescent mental disorders.
A mental health questionnaire can elicit responses that identify possible problems: depression, anxiety disorder, substance use disorder or suicidal thoughts or attempts — conditions that are best treated early.
A mental health screen can be an effective and accurate tool, and yet some primary care providers still avoid them. They’re concerned that their training hasn’t prepared them to address mood or behavioral problems. They may not be familiar with mental health services in their area. If they encounter a positive score, they may be unsure of what to do next. These are valid concerns and deserve careful consideration. But, they are not an excuse to avoid screening. The prevalence of these disorders are too high, and the symptoms too debilitating to omit screening from the adolescent check-up.
More than 11% of U.S. children and adolescents suffer from a serious mental disorder that causes significant impairment, yet 70% are not identified and do not receive mental health services. Half of all mental disorders emerge by age 14. Left untreated, depression and mental health disorders can lead to decreased school performance, substance abuse, emotional distress, and the potential for suicide. Conversely, treatment success rates range from 60-80%.
Primary care providers need to ask themselves: Would you avoid screening for developmental delays even though you’re not a neurologist? Would you decide against lead poison screenings because you’re not a hematologist? Most providers would look askance if you suggested such things.
Screening is far and away more effective than asking teens open-ended questions in a psychosocial interview. Research has shown that screening can be significantly more accurate than the informal interview method – which may miss about 50% of at-risk teens.
While it is certainly true that we need to supplement our primary care training, we are grounded in the management of pediatric chronic disease. Working with specialists, we co-manage asthma, diabetes, neurological disorders and other serious illnesses. We are well-positioned to be on the front lines of teen mental health.
There are numerous resources – from NAPNAP, TeenScreen National Center, the American Academy of Pediatrics and others — readily available to assist primary care providers in improving their skills and knowledge about adolescent mental health, treatment, community resources, motivational interviewing, cognitive behavioral therapy, and pharmacotherapy.
When primary care providers make teen mental health a priority, they’re often impressed by the frequency of positive results, and surprised at how they would not have detected a problem otherwise.