February 19, 2009

Adolescent Mental Health: Service Settings and Reasons for Receiving Care

Mental health services are available to adolescents in three major settings: a specialty mental health setting (inpatient and outpatient services); a school-based educational setting (services received from school counselors, school psychologists, or special education teachers); and a general medical setting (services received from pediatricians or family practice providers). Although help-seeking typically may focus on settings that are familiar and easily accessible, different problems may tend to cluster in different settings, depending on the type of problem experienced. It is important for mental health service planners and providers to be aware of the reasons for which adolescents are receiving services in various settings in order to address the mental health care needs of adolescents.

This issue of The NSDUH Report provides data on mental health treatment or counseling for emotional or behavioral problems received by adolescents (i.e., youths aged 12 to 17) in the past year, including the service settings and the reasons for receiving care the last time.¹ All findings presented in this report are based on data from the 2007 National Survey on Drug Use and Health (NSDUH).

One in eight adolescents (12.5 percent) received specialty mental health services (inpatient or outpatient) for emotional or behavioral problems in the 12 months prior to the survey (Table 1). Over one tenth (11.1 percent) received outpatient specialty mental health services, with private therapists, psychologists, psychiatrists, social workers, or counselors providing these services to 9.4 percent of adolescents. Inpatient or residential specialty care was received by 2.5 percent of adolescents, with 2.0 percent indicating they were hospitalized to receive treatment for emotional or behavioral problems.

Over one tenth (11.5 percent) of adolescents received mental health services in an educational setting, with 9.7 percent indicating that they had received services from a school counselor or school psychologist or through regular meetings with a teacher. Receiving mental health services from a pediatrician or other family doctor in a general medical setting was mentioned by 2.8 percent of adolescents. One in twenty (5.1 percent) adolescents received services in both a specialty mental health setting and an educational or general medical setting in the past year.

Female adolescents were more likely than their male counterparts to have received mental health services in the past year in outpatient specialty settings (13.3 vs. 9.1 percent), educational settings (13.2 vs. 9.9 percent), or general medical settings (3.2 vs. 2.3 percent), but there was no gender difference in the receipt of care in inpatient specialty settings (Figure 1).

Figure 1. Percentages Receiving Mental Health Services in the Past Year among Adolescents, by Service Setting* and Gender: 2007

Adolescents who received services in the past 12 months were asked to indicate the reasons for receiving care at their last visit. Among adolescents who received specialty outpatient mental health services, feeling depressed was the most commonly mentioned reason for receiving care at the last visit (50.4 percent) (Table 2). Feeling depressed was also the most commonly mentioned reason among those who received care through general medical and educational settings at the last visit (44.3 and 38.0 percent, respectively). Among those who received specialty inpatient care, thinking about or attempting suicide was mentioned as often as feeling depressed (44.9 and 44.8 percent, respectively). In comparison, suicidal thoughts or attempts were mentioned by less than 20 percent of adolescents receiving services in settings other than inpatient specialty care. Among adolescents who reported specialty mental health services and educational or general medical services, feeling depressed was the most common reason for receiving care at the last visit.

Problems at home or with the family also were commonly mentioned as reasons for receiving services at the last visit among adolescents receiving outpatient specialty care (29.0 percent). Breaking rules or "acting out" was mentioned by about a quarter of all adolescents receiving services across most settings. Problems at school were mentioned by about a quarter (23.6 percent) of those receiving services through an educational setting.

Females were generally more likely than males to mention each reason for receiving services in each setting (data not shown). One notable exception was that breaking rules or "acting out" was more likely to be mentioned by males than females receiving services through an educational setting (31.9 vs. 18.3 percent).

Adolescents receive mental health services in a variety of settings, with the outpatient specialty and educational settings being the most frequently mentioned. Feeling depressed was the most commonly cited reason for receiving services across settings. Services for suicidal thoughts and attempts were mentioned most commonly by adolescents who received care in a specialty mental health setting, particularly inpatient care. Educators and health care providers may be among the first to be contacted about mental health issues among adolescents. Therefore, it is important to ensure that these professionals are equipped to recognize mental health problems and to direct adolescents toward appropriate services. This also underscores the importance of ensuring that adolescents with mental, emotional, or behavioral problems and their families have access to needed services.