community conversations about mental...

Community Conversations About Mental Health

Information Brief

On January 16, 2013, President Barack Obama directed Secretary Kathleen Sebelius of the U.S. Department of Health and Human Services and Secretary Arne Duncan of the U.S. Department of Education to launch a national conversation on mental health to reduce the shame and secrecy associated with mental illness, encourage people to seek help if they are struggling with mental health problems, and encourage individuals whose friends or family are struggling to connect them to help.

Mental health problems affect nearly every family. Yet as a nation, we have too often struggled to have an open and honest conversation about these issues. Misperceptions, fears of social consequences, discomfort associated with talking about these issues with others, and discrimination all tend to keep people silent. Meanwhile, if they get help, most people with mental illnesses can and do recover and lead happy, productive, and full lives.

This national dialogue will give Americans a chance to learn more, from research and from each other, about mental health issues. People across the nation are organizing community conversations to assess how mental health problems affect their communities and to discuss topics related to the mental health of young people. In so doing, they also will decide how they might take action to improve mental health in their families, schools, and communities. This could include a range of possible actions to establish or improve prevention of mental illnesses, promotion of mental health, public education and awareness, early identification, treatment, crisis response, and recovery supports available in their communities.

These community conversations will encourage innovation and creativity to meet the concerns of our nation and ensure that all perspectives are heard and respected. We all have a stake in the outcomes.

Mental health issues in our communities—particularly for our youth—are complex and challenging; but, by coming together and increasing our understanding and raising awareness, we can make a difference.

Pamela S. Hyde, J.D.AdministratorSAMHSA

Paolo del Vecchio, MSWDirectorCenter for Mental Health ServicesSAMHSA

Falzones

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/Pamela S. Hyde, J.D./

Falzones

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/Paolo del Vecchio, MSW/


Goals and Objectives of the Community Conversations About Mental Health

This toolkit is designed to help participants in community conversations about mental health achieve three main goals:

• GetAmericanstalkingaboutmentalhealthtobreakdownmisperceptionsandpromoterecoveryandhealthycommunities;

• Findinnovativecommunity-basedsolutionstomentalhealthneeds,withafocusonhelpingyoungpeople;and

• Developclearactionstepsforcommunitiestomoveforwardinawaythatcomplementsexistinglocalactivities.

The Information Brief for Community Conversations About Mental Health

The Information Brief is designed to be used alongside the other elements of the Toolkit for Community Conversations About Mental Health and provides data and information to help community conversations participants consider key issues of importance to their com-munities. The Information Brief follows the format of the Discussion Guide section of the Toolkit for Community Conversations About Mental Health and has the following sections:

• Session1:StartingtheConversationOpening Question: What does mental health mean to me? What does it mean to our community?

• Session2:IdentifytheChallengesOpening Question: What are the challenges and factors we should consider?

• Session3:FocusingonYouthOpening Question: How can we best support the mental health of young people?

• Session4:CommunitySolutionsOpening Question: What steps do we want to take in our community?

Table of ContentsGoals and Objectives of the Community Conversations About Mental Health

The Information Brief for Community Conversations About Mental Health

Terms and Definitions .................................................... 1

Session 1: Starting the Conversation ....................3

Understanding the Basics ..........................................3

Attitudes and Beliefs About Mental Health .....................................................................6

Mental Health in the Community ...........................7

Research About the Mental Health of Young People ............................10

Session 2: Identify the Challenges .........................11

Session 3: Focusing on Youth ................................14

Session 4: Community Solutions ......................... 17

Appendix 1: Helpful Resources and Websites .................................................................... 19

Appendix 2: Acknowledgments ........................20

Reference List ................................................................. 21


Information Brief

Community Conversat ions About Menta l Hea l th

Acknowledgments

ThisreportwaspreparedfortheSubstanceAbuseandMentalHealthServicesAdministration(SAMHSA)byAbtAssociatesanditssubcontractorstheDeliberativeDemocracyConsortium,andEverydayDemocracyundercontractnumber[HHSS283200700008I/HHSS28342002T]withSAMHSA,U.S.DepartmentofHealthandHumanServices(HHS).L.WendieVelozandChrisMarshallservedastheGovernmentProjectOfficers.

Disclaimer

Theviews,opinions,andcontentofthispublicationarethoseoftheauthoranddonotnecessarilyreflecttheviews,opinions,orpoliciesofSAMHSAorHHS.Thelistingofanynon-Federalresourcesisnotall-inclusiveandinclusioninthispublicationdoesnotconstituteendorsementbySAMHSAorHHS.

Public Domain Notice

AllmaterialappearinginthisreportisinthepublicdomainandmaybereproducedorcopiedwithoutpermissionfromSAMHSA.Citationofthesourceisappreciated.However,thispublicationmaynotbereproducedordistributedforafeewithoutthespecific,writtenauthorizationoftheOfficeofCommunications,SAMHSA,HHS.

Electronic Access and Printed Copies

Thispublicationmaybedownloadedororderedathttp://store.samhsa.gov.OrcallSAMHSAat1-877-SAMHSA-7(1-877-726-4727)(EnglishandEspañol).

Recommended Citation

SubstanceAbuseandMentalHealthServicesAdministration,CommunityConversationsAboutMentalHealth:InformationBrief.HHSPublicationNo.SMA-13-4763.Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration,2013.

Originating Office

OfficeofCommunications,SubstanceAbuseandMentalhealthServicesAdministration,1ChokeCherryRoad,Rockville,MD20857.HHSPublicationNo.SMA-13-4763.PrintedJune2013.

SAMHSA Descriptor

TheSubstanceAbuseandMentalHealthServicesAdministration(SAMHSA)istheagencywithintheU.S.DepartmentofHealthandHumanServicesthatleadspublichealtheffortstoadvancethebehavioralhealthofthenation.SAMHSA’smissionistoreducetheimpactsubstanceabuseandmentalillnessonAmerica’scommunities.

11Informat ion Br ie f

Terms and DefinitionsBefore we start looking at these central questions, let’s define some terms that will be used heavily throughout this informational brief:

Mental Healthisastateofwell-beinginwhichanindividualrealizeshisorherownabilities,cancopewiththenormalstressesoflife,canworkproductively,andisabletomakeacontributiontohisorhercommunity.Inthispositivesense,mentalhealthisthefoundationforindividualwell-beingandtheeffectivefunctioningofacommunity.1

Mental Illness isdefinedas“collectivelyalldiagnosablementaldisorders”or“healthconditionsthatarecharacterizedbyalterationsinthinking,mood,orbehavior(orsomecombinationthereof)associatedwithdistressand/orimpairedfunctioning.”Underthesedefinitions,substanceusemightbeclassifiedaseitheramentalhealthproblemoramentalillness,dependingonitsintensity,duration,andeffects.2

Mental Health Promotionconsistsofinterventionstoenhancetheabilitytoachievedevelopmentallyappropriatetasksandapositivesenseofself-esteem,mastery,well-being,andsocialinclusionandtostrengthentheabilitytocopewithadversity.3Thisabilitytocopeisreferredtoasresilience.

Mental Health Treatment istheprovisionofspecificinterventiontechniquesbyaprofessionalforconditionsidentifiedinthemostrecenteditionoftheDiagnosticandStatisticalManualofMentalDisorders(DSM).Theseinterventionsshouldhaveproveneffectiveness,theabilitytoproducemeasurablechangesinbehaviorsandsymptoms,andshouldbeperson-andfamily-centeredandculturallyandlinguisticallyappropriate.4

Prevention isasteporsetofstepsalongacontinuumtopromoteindividual,family,andcommunityhealth;preventmentalandsubstanceusedisorders;supportresilienceandrecovery;andpreventrelapse.5

2 Community Conversat ions About Menta l Hea l th

Terms and Definitions Recoveryisaprocessofchangethroughwhichindividualsimprovetheirhealthandwellness,liveaself-directedlife,andstrivetoreachtheirfullpotential.Peoplewithmentalillnessescananddorecoverfromtheseconditions,andhopeplaysanessentialpartinovercomingtheinternalandexternalchallenges,barriers,andobstacles.Controllingormanagingsymptomsispartofthisprocess.Reducingoreliminatingsubstanceuseiscriticalforrecoveryfromaddiction.6

Recovery Support Services includeafocusonprovidingforthehealth,housing,vocational,andsocialsupportneedsofpeoplewithmentalhealthproblems.Theseincludepeer-andfamily-operatedservices.7

Substance Abuseisdefinedastheuseofalcoholordrugsdespitenegativeconsequences.8

Substance Useisdefinedastheconsumptionofloworinfrequentdosesofalcoholandotherdrugs,sometimescalledexperimental,casual,orsocialuse.9

Traumaresultsfromanevent,seriesofevents,orsetofcircumstancesthatisexperiencedbyanindividualasphysicallyoremotionallyharmfulorthreateningandthathaslastingadverseeffectsontheindividual’sfunctioningandphysical,social,emotional,orspiritualwell-being.10

Young People/Youth aredefinedhereaspersonsuptoage25.

3In format ion Br ie f

Session 1: Starting the ConversationWhat Does Mental Health Mean to Me? What Does It Mean to Us?

There are many views and opinions about mental illnesses, their causes, and how we can best treat and respond to these conditions. The following information provides some basic facts about mental health and mental illness to help participants begin the conversation.

Understanding the Basics

Mentalhealthplaysanimportantroleinyouroverallwell-being.Anestimated19.6percentofAmericansages18andolder—aboutoneinfiveadults—willexperienceamentalhealthproblemthisyear.11Butstudiesshowthatmostpeoplewithmentalproblemsgetbetter,andmanyrecovercompletely.

Mentalhealthincludesouremotional,psychological,andsocialwell-being.Itaffectshowwethink,feel,andact.Italsohelpsdeterminehowwehandlestress,relatetoothers,andmakechoices.Mentalhealthisimportantateverystageoflife,fromchildhoodandadolescencethroughadulthood.

Overthecourseofyourlife,youmayexperiencementalhealthproblems.Yourthinking,mood,andbehaviorcouldbeaffected.12

Manyfactorscontributetomentalhealthproblems,including:

• Lifeexperiences,suchastraumaorahistoryofabuse• Biologicalfactors,suchasgenesorchemicalimbalancesinyourbrain• Familyhistoryofmentalhealthproblems

Takingcareofone’smentalhealthisjustasimportantastakingcareofone’sphysicalhealth.Overallhealthincludesawell-balancedandnutritiousdiet,regularexercise,stressmanagement,earlyandongoingmentalhealthserviceswhenneeded,andtakingtimetorelaxandenjoyfamilyandfriends.Findingagoodbalancebetweenworkandhomeisimportanttomentalandphysicalhealth.


Types of Mental Health Problems

Peoplecanexperiencedifferenttypesofmentalhealthproblems.Somecanoccurforashorttime,andsomeoccuroveranon-goingtimeperiod.Justasotherhealthconditions,thesearerealanddiagnosablehealthconditionsthataffectandareaffectedbyfunctioningofthebrain,anorganofthebodyjustlikethekidney,liver,orheart.Mentalhealthproblemscanaffectyourthinking,mood,andbehavior.Commontypescaninclude:13

Anxiety DisordersPeoplewithanxietydisordersrespondtocertainobjectsorsituationswithfearanddread.Anxietydisorderscanincludeobsessive-compulsivedisorder,panicdisorders,phobias,andPost-TraumaticStressDisorder(PTSD).

Attention Deficit Hyperactivity DisorderAttentiondeficithyperactivitydisorder(ADHD)isoneofthemostcommonchildhooddisordersandcancontinuethroughadolescenceandadulthood.Symptomsincludedifficultystayingfocusedandpayingattention,difficultycontrollingbehavior,andhyperactivity(over-activity).

Eating DisordersEatingdisordersinvolveextremeemotions,attitudes,andbehaviorsinvolvingweightandfood.Eatingdisorderscanincludeanorexia,bulimia,andbingeeating.

Co-Occurring Mental and Substance Use DisordersMentalillnessesandsubstanceusedisordersoftenoccurtogether.Sometimesonedisordercanbeacontributingfactortoorcanexacerbatetheother.Sometimestheysimplyoccuratthesametime.

Mood DisordersThesedisordersinvolvepersistentfeelingsofsadnessorperiodsoffeelingoverlyhappy,orfluctuatingbetweenextremehappinessandextremesadness.Mooddisorderscanincludedepression,bipolardisorder,SeasonalAffectiveDisorder(SAD),andcompulsiontoself-harm.

Personality DisordersPeoplewithpersonalitydisordershaveextremeandinflexiblepersonalitytraitsthataredistressingtothepersonand/orcauseproblemsinwork,school,orsocialrelationships.Personalitydisorderscanincludeantisocialpersonalitydisorderandborderlinepersonalitydisorder.

Psychotic DisordersPeoplewithpsychoticdisordershear,see,andbelievethingsthataren’trealortrue.Anexampleofapsychoticdisorderisschizophrenia.

Substance Use DisordersSubstanceusedisordersinvolvethedependenceonorabuseofalcoholand/ordrugs,includingthenonmedicaluseofprescriptiondrugs.14

Suicidal BehaviorSuicideisaseriousproblemthatcausesimmeasurablepain,suffering,andlosstoindividuals,familiesandcommunitiesnationwide.Millionsofpeopleconsider,plan,orattemptsuicideeachyear;manydieasaresult.


Promotion of Mental Health and Prevention of Mental Illnesses

Whenwepromotementalhealth,wehelppeopleimprovetheirhealthandwell-being,havepositiveself-esteem,andtobevaluedandcontributingmembersoftheircommunities.Mentalhealthpromotionalsohelpsbuildresiliencyinpeople,helpingthemcopebetterduringlife’schallenges.

Preventioninterventionshelptoreducethelikelihoodofdevelopingamentalillnessorasubstanceusedisorderandcanhelpdelaytheonsetorreducetheseverityofamentalillness.Preventionaddressesproblemsbeforetheyhappenbyaddressingthosethings–riskfactors–thatcanmakeitmorelikelyforapersontodevelopproblems.Thesecanincludeworkingtocreatehealthyenvironmentsthatreducetheeffectsofpovertyandtheriskofviolence,childmaltreatment,drug/alcoholmisuse,andbullyingandensurethatpeoplehaveaccesstothecarethattheyneedwhensymptomsjustbegintoappear.Preventioneffortsfocusoncommunitiesorlargepopulationsthroughuniversalstrategiesorinterventionstargetedathigh-riskindividualsandthosewhomaybeshowingsomeminimalsignsandsymptomsofdevelopingamentalillnessorasubstanceusedisorder.

Someimportantwaysthatwecanpromotementalhealthandpreventmentalillnessandsubstanceusedisordersistoincreaseprotectivefactorsandusepromisingstrategiesthataddresstheneedsofchildren,adults,andfamiliesinthecommunity.Protectivefactorsincludegoodcommunicationskills,reliablesupportanddisciplinefromparentsandcaregivers,supportforearlylearning,qualityhealthcare,healthypeergroups,socialconnectedness,andsucceedingschools.Promisingstrategiesemphasizepubliceducationandawarenessaboutissuesrelatedtomentalhealthandsubstanceuse-andincludeearlyidentificationofmentalhealthproblemsandaccesstoappropriateinterventions.

Treatment for Mental Health Problems

Mostpeoplewhoexperiencementalillnesseswillimproveiftheyreceiveappropriatesupports,services,andtreatment.Thefirststeptogettingtherighttreatmentistoseeahealthcareprofessionalandreviewyoursymptomsandlifecircumstances.Treatmentoptionsaretailoredtoeachspecificpersonandcondition;however,themostcommonformsoftreatmentinclude:

• Psychotherapy, or “talk therapy” (sometimes called counseling)—teachespeoplestrategiesandgivesthemtoolstodealwithstressanduncomfortablethoughtsandbehaviors.Psychotherapyhelpspeoplemanagetheirsymptomsbetterandfunctionattheirbestineverydaylife.15

• Cognitive behavioral therapy (CBT)—helpspeoplelearnhowtoidentifyunhelpfulthinkingpatterns,recognizeandchangeinaccuratebeliefs,relatetoothersinmorepositiveways,andchangebehaviorsaccordingly.CBTcanbeappliedandadaptedtotreatmanyspecificmentaldisorders.16


• Medications—usedtotreatthesymptomsofmanymentaldisorderssuchasschizophrenia,depression,bipolardisorder(sometimescalledmanic-depressiveillness),anxietydisorders,andattentiondeficit-hyperactivitydisorder(ADHD).Medicationscanalsobeusedtomanagethecravingsandrelapseassociatedwithcertainkindsofaddictions.Sometimesmedicationsareusedwithothertreatmentssuchaspsychotherapyorcounseling.17

• Rehabilitative services—includerecovery-focusedactivitiesortreatment/therapeuticinterventionssuchasassistanceinimprovingorrestoringdailylivingskills,socialandleisureskills,groomingandpersonalhygieneskills,andmealpreparationskills;othersupportresources;and/ormedicationeducation.

Recovery from Mental Health Problems

Studiesshowthatmostpeoplewithmentalhealthproblemsgetbetter,andmanyrecovercompletely.Recoveryisdefinedasaprocessofchangethroughwhichindividualsimprovetheirhealthandwellness,liveaself-directedlife,andstrivetoreachtheirfullpotential.Recoveryissupportedbymentalhealthtreatmentandsupportservicesinthecommunity.18

Recoveryisbuilton:

• Health—overcomingormanagingone’sdisease(s)orsymptoms–includingabstinenceifonehasanaddiction–andmakinginformed,healthychoicesthatsupportphysicalandemotionalwellbeing.

• Home—astableandsafeplacetolive.

• Purpose—meaningfuldailyactivities,suchasajob,school,volunteerism,familycaretaking,orcreativeendeavorsandtheindependence,income,andresourcestoparticipateinsociety.

• Community—relationshipsandsocialnetworksthatprovidesupport,friendship,love,andhope.

Attitudes and Beliefs About Mental HealthWeknowalotaboutwhatAmericansbelieveaboutmentalhealthandmentalillnessfromnationalsurveys.ThesesurveysrevealthatwhileAmericanshavelearnedagreatdealaboutcharacteristicsandcausesofmentalillnessesoverthelastseveraldecades,negativebeliefsaboutpeoplewithmentalillnessescontinuetogrow.19

Thesenegativeattitudesaboutpeoplewithmentalillnessesaremostlyinfluencedbythemisconceptionthatpeoplewithmentalillnessesaremoreviolentthanthegeneralpopulation.20Peoplewithmentalillnessesarenomoreviolentthanthegeneralpopulationunlesscertainotherriskfactorsareinvolved,includingalcoholabuseoruntreated,activepsychosisassociatedwithparanoiaandincludingspecifictypesofcommandhallucinations.21Infact,peoplewithmentalillnessesonlycommitthreetofivepercentofviolentactseveryyear.22Peoplewithmentalillnessesaremuchmorelikelytobevictimsofcrimethanperpetrators.23


Impact of Attitudes and Beliefs

People’sattitudesandbeliefsaboutmentalillnesssetthestageforhowtheyinteractwithandsupportapersonwithmentalillness.

• Whenpeoplehavepositiveattitudesaboutmentalhealth,theymayengageinsupportiveandinclusivebehaviors(e.g.,willingnesstodateapersonwithmentalillnessortohireapersonwithmentalillness).24

• Whenattitudesandbeliefsareexpressednegatively,theymayresultinavoidance,exclusionfromdailyactivities,and,intheworstcase,exploitationanddiscrimination.25

Attitudesandbeliefsaboutmentalillnessareshapedbypersonalknowledgeaboutmentalillnessandknowingandinteractingwithsomeonelivingwithamentalillness.Attitudesandbeliefscanbeinfluencedbyculturalstereotypes,mediastories,andinstitutionalpractices.

Mental Health in the CommunityTherearemanyintertwinedfactorsthatinfluencethementalhealthofanindividualandtheresourcesavailableinacommunitytomeettheneedsofpeoplewithmentalhealthproblems.

Spirituality and Mental Health

Manyturntofaithcommunitiesforsupportindealingwithmentalhealthproblems.Faithcanprovideimportantelementsofsolaceandsupportforsuchindividuals.Faithcommunitiescanalsoplayakeyroleineducatingtheirmembersaboutmentalhealthproblems.26Supportiverelationships,suchasfamily,long-termfriendships,andmeaningfulonnectionsthroughfaithcanbeimportanttobuildingresilienceandwell-being.

Culture and Mental Health

Culturecanprovidealensforhowpeoplethinkaboutmentalhealth,whethertheyseekhelpformentalhealthproblems,andhowpeopleandmentalhealthprofessionalsinteractwithoneanother.27Peopletypicallythinkofcultureintermsofraceorethnicity,butculturealsoreferstoothersocialgroupsdefinedbycharacteristicssuchasage,gender,religion,incomelevel,education,geographicallocation,sexualorientation,disability,orprofession.28Ratesandtypesofmentalhealthproblemsandseekingtreatmentcanvaryaccordingtothepopulation.29Racialandethnicminoritiesbearagreaterburdenfromunmetmentalhealthneedsandsufferagreaterlosstotheiroverallhealthandproductivity.30


Mental Health is a Public Health Issue

Providingforandsupportinggoodmentalhealthisapublichealthissuejustlikeassuringthequalityofdrinkingwaterorpreventingandmanaginginfectiousdiseases.Communitiesprosperwhenthementalhealthneedsofcommunitymembersaremet.Unaddressedmentalhealthissuescanhaveanegativeinfluenceonhomelessness,poverty,employment,safety,andthelocaleconomy.Foryoungpeople,mentalhealthisinfluencedbyawebofinteractionsamongtheyoungperson,thefamily,childservicesystems(school,health,fostercare),andtheneighborhoodsandcommunitiesinwhichtheylive.

• ApproximatelyoneinfiveAmericanswillhaveamentalhealthprobleminanygivenyear,yetonlyalittleoveroneinthreepeoplewithamentalhealthproblemwillreceivementalhealthservices.31

• Over38,000Americansdiedbysuicidein2010,makingthenumberofAmericanswhodiebysuicidemorethandoublethenumberwhodiedbyhomicide.32

• One-thirdofindividualswithseverementalillnesseswhoreceivecommunitymentalhealthservicesafterlengthystaysinastatehospitalachievefullrecoveryinpsychiatricstatusandsocialfunction,andanotherthirdimprovesignificantlyinbothareas.33

• Ofthemorethansixmillionpeopleservedbystatementalhealthauthoritiesacrossthenation,only21percentareemployed.34

• Supportedemploymentprogramsthathelppeoplewiththemostseriousmentalillnessesplacemorethan50percentoftheirclientsintopaidemployment.35

• Between2007-2009,theaverageexpenditureperadultages18-26forthetreatmentofmentalhealthdisorderswasabout$2,000.Ofthispopulation,averageexpenditurefortreatmentofmentalhealthproblemswashigherforyoungadultsages18-21estimatedat$2,300peryearthanforthoseages22–26estimatedat$1,800.36

• In2006,186,000youngadultsreceivedsocialsecuritydisabilitybenefitsbecausetheirmentalillnesswassoseverethattheywerefoundtobeunabletoengageinsubstantialgainfulactivity.37

• SeriousmentalillnessescosttheU.S.anestimated$193.2billioninlostearningsperyear.38Effectivenationwideschool-basedsubstanceabusepreventionprogrammingcanofferstatessavingswithin2yearsrangingfrom:39

o $36millionto$199millioninjuvenilejustice40

o $383millionto$2.1billionineducation41

o $68millionto$360millioninhealthservices42

Homelessness, Mental Health, and the Community

From the January 2010 HUD Point-in-Time (PIT) counts, Continuums of Care reported that:

• 26.2 percent of sheltered adults who were homeless had a severe mental illness, and

• 46 percent of sheltered adults on the night of the PIT count had a chronic substance abuse problem and/or a severe mental illness.

Prejudice and discrimination associated with mental and substance use disorders create enormous housing challenges for these individuals.43

Did You Know?


Substance Abuse and Communities

SubstanceabusetakesatremendoustollonAmerica’scommunities.Mentalandsubstanceuseconditionsoftenco-occur.Inotherwords,individualswithsubstanceuseconditionsoftenhaveamentalhealthconditionatthesametime,andpersonswithmentalhealthproblemsoftenabusesubstancesorexperienceaddictionatthesametime.Thefollowingincludesstatisticsonsubstanceabuseandco-occurringmentalandsubstanceusedisorders:

• In2011,anestimated20.6millionpersons(8.0percentofthepopulationaged12orolder)wereclassifiedwithsubstancedependenceorabuseinthepastyear.44

• 19.3millionpersons(7.5percentofthepopulationaged12orolder)neededtreatmentforanillicitdrugoralcoholuseproblembutdidnotreceivetreatment.45

• Approximatelyeightmillionadultshaveco-occurringdisorders.46

• Only6.9percentofindividualsreceivetreatmentforbothconditionswhile56.6percentreceivenotreatmentatall.47

• Co-occurringmentalandsubstanceusedisorderratesarehighamongpeoplewhoexperiencehomelessness.48

• Onestudyreporteda23percentlifetimeprevalencerateofco-occurringdisordersforindividualswhoexperiencehomelessness,andthesepeoplemayfacecomplexphysical,social,andpsychologicalchallengestorecovery.49

• Withtreatment,emergencyroomvisits,hospitalstays,andperiodsofincarcerationaresignificantlyreduced.50Likewise,high-riskandharmfulsubstanceuseisdecreased.Stablehousingalongwithsupportiveservicesprovidesahigherquality,self-directed,andsatisfyinglifeinthecommunity.51

The Treatment Gap in AmericaAlmost two-thirds of the over 45 million adults with any mental illness and almost 90 percent of the over 21 million adults with substance use disorders go without treatment in our country every year.52

Did You Know?


Research About the Mental Health of Young People

Theresearchsupportstheneedforpreventionandearlyinterventionstrategiestoaddressthemental,emotionalandbehavioralproblemsthatcanoccurthroughoutayoungperson’slife.

• MorethanhalfofadolescentsintheUnitedStateswhofailtocompletehighschoolhaveadiagnosablepsychiatricdisorder.53

• Individualswithmentalillnessesdieonaverage8.5yearsearlierthanthegeneralpopulation,duemostlytopreventablehealthconditionslikeheartdisease,diabetes,hypertension,andtobaccouse.54

• Bullyingcanhavesignificantmentalhealthconsequencesforbothvictimsandbullies.55

o Comparedtoindividualswhowerenotbullied,victimsofbullyingwerenearlythreetimesaslikelytohaveissueswithgeneralizedanxietyasthosewhowerenotbulliedand4.6timesaslikelytosufferfrompanicattacksoragoraphobia.

o Childrenwhoreportedbeingbothbulliesandvictimsshowedanearlyfivetimesgreaterriskofdepressionasyoungadultscomparedtothosewhohadonlyexperiencedbeingabullyoronlyexperiencedbeingavictim.

• Researchhasdemonstratedthatpreventioneffortscandelaythefirstuseoftobaccoandalcohol.56

• Bingedrinkingandheavyalcoholusepeaksbetweenthoseaged18-25,withnearly40percentofpeopleinthatagegroupreportingbingedrinkingand12percentreportingheavyalcoholuse.57

• Abuseofprescriptiondrugsishighestamongyoungadultsaged18to25,with5percentreportingnonmedicaluseinthepastmonth.58

• DatafromSAMHSA’sChildren’sMentalHealthInitiativeindicatedthatamongyouth12andolderwhoidentifiedsubstanceuseproblemsatintakeinChildren’sMentalHealthInitiative-fundedsystemsofcare,36percentinvolvedwiththechildwelfaresystemand32percentinvolvedwiththejuvenilejusticesystemreportednosubstanceuseproblemsafter6months.59

• Bypreventingachildfrombecomingdependentonalcohol,wecansaveapproximately$700,000overthecourseofthechild’slifetime.60

• Byhelpingachildgraduatefromhighschoolwhowouldotherwisehavedroppedout,wecansaveasmuchas$388,000overthecourseofthechild’slifetime.61


Session 2: Identify the ChallengesWhat Are the Challenges and Factors We Should Consider?

To make progress on mental health issues, we need to think strategically about the challenges we are facing and the factors that have the greatest influence on mental health—particularly those that affect young people. This session will help you consider some of those challenges and factors and begin thinking about how to address them.

Challenges to Promoting Mental Health

Inthepast,thesciencedidnotexistabouthowtoeffectivelypromotementalhealthandpreventmentalillnesses.Now,wehavetheknow-howbutstillneedtoeducatecommunities,serviceproviders,andothersthatpreventionispossible.Promotionandpreventionwillhelpustoultimatelyreducedisabilityandhardshipbyreducingtheprevalenceofmentalhealthdisorders.62

Promotionandpreventioninvolvesanewapproachtomentalhealthissues.Thisapproachrequirespeopleandcommunitiestothinkandactdifferentlybyaddressingmentalhealthissuesbeforetheybecomementalillnesses.

Challenges for Youth Transitioning to Adulthood

Asyouthbecomeadults,alargenumberhavebehavioralhealthproblems,andveryfewactuallyreceivetreatment.

• YouthtransitioningtoadulthoodtypicallyhavedifficultiesaccessinghealthcareandthehighestuninsuredrateintheUnitedStates.64Additionally,theyoftenhavelowperceptionsofrisk65althoughthispopulationhasthehighestrateofhomicide,66andhighratesofhomelessness,67arrests,68mentalhealthproblems,69schooldropouts,70andsubstanceabuse.71

• Itisestimatedthat6-12percentoftransition-ageyouthandyoungadultsstrugglewithaseriousmentalhealthcondition(2.4-5millionindividuals).72

• AccordingtotheTreatmentEpisodeDataSetfor2009,amongsubstanceabusetreatmentadmissionsaged12to17,fewerthanoneineight(11.9percent)werereferredbyschools.73

• Treatmentadmissionsaged15to17mostfrequentlyreportedmarijuana(71.9percent)oralcohol(17.7percent)astheirprimarysubstanceofabuse.74

The Importance of Involving Families

Family-driven care means that families have a decision-making role in the care of their own children as well as the policies and procedures that shape care for children in their community, state, tribe, territory, and nation.63

Did You Know?


Did You Know?

Economic Costs of Mental Health Problems

The annual cost of mental, emotional, and behavioral disorders among young people is estimated to be $247 billion – including the costs of treatment and lost productivity.79

Access to Support, Services, and Treatment

Attitudesandbeliefscanpreventapersonfromseekingtreatment,althoughresearchtellsusthattreatmentiseffectiveandpeopledorecover.

• Only38percentofadultswithdiagnosablementalhealthconditionsgettreatment.Ofthe45.9millionpeople18andolderwhohavebehavioralhealthconditions,just17.9millionreceivedtreatment.75

• Lessthanoneinfiveadolescentsgettreatmentfordiagnosablementalhealthconditions.76

• Aswithotherchronicillnesses,individualswhoseektreatmentandrecoverysupportservicesformentalhealthproblemslearnnewlifeskillsandgoontolivehealthy,empowered,andproductivelives.77

• Stablehousingisimportanttoindividualsseekingtreatmentandfordeliveringservicestothepersonintheirlivingenvironmentandcommunity.Throughresearchweknowthattreatmentiseffectiveandrecoveryispossiblebutnotwhenaperson’sbasicneedforsafetyandhousingarelacking.78

Paying for Mental Health Care

• Lackofabilitytoaffordcareisamongthetopreasonsthatpeoplewithunmetneedreportedfornotseekingtreatment.80

• Peoplewithmentalhealthandsubstanceabuseproblemshavehistoricallyhadhighratesofbeinguninsured.81

• Asaconsequence,mentalhealthandsubstanceabusetreatmentspendinghasdependedmoreonpublicpayersthanallhealthcare,withpublicpayers—suchasMedicaid—accountingforapproximately60percentofmentalhealthspending.82

• AsaresultoftheAffordableCareAct,manycurrentlyuninsuredAmericanswithmentalhealthandsubstanceabuseproblemswillbecomeeligibleforaffordablehealthinsurancecoverage.Beginningin2014underthelaw,allnewsmallgroupandindividualmarketplanswillberequiredtocovertenEssentialHealthBenefitcategories,includingmentalhealthandsubstanceusedisorderservices,andwillberequiredtocoverthematparitywithmedicalandsurgicalbenefits.TheMentalHealthParityandAddictionsEquityAct(MHPAEA)requiresgrouphealthplansandinsurersthatoffermentalhealthandsubstanceusedisorderbenefitstoprovidecoveragethatiscomparabletocoverageforgeneralmedicalandsurgicalcare.Asaresultofthesetwopiecesoflegislation,anestimated62millionAmericanswillhaveimprovedaccesstoservicesformentalandsubstanceusedisorders.83


Perceptions of Violence and Mental Illness

Toooften,depictionsandperceptionsofviolenceandmentalillnesscanperpetuatenegativeattitudesandmythsaboutindividualslivingwithamentalillness.

• Peoplewithmentalillnessesonlycommitthreetofivepercentofviolentactsandaremuchmorelikelytobevictimsthanperpetratorsofviolence.84

• Researchhasdemonstratedthatindividualswhoreceivedtreatmentformentalillnessesinthecommunity(outpatient,day,andresidentialtreatment)were11timesmorelikelytohavebeenthevictimsofviolentcrimethanthegeneralpopulationinthepastyear.85

Criminal Justice Involvement

Nevertheless,therearehighratesofmentalillnessesandsubstanceabuseproblemsamongpeopleinthecriminaljusticesystem.

• Approximately70percentofjailinmateswithmentalillnessesareincarceratedfornon-violentoffenses.86

• In2005,individualswhoexperiencedmentalhealthproblemsaccountedfor56percentofstateprisoners,45percentoffederalprisoners,and64percentofjailinmates.87

• Sixty-seventoseventypercentofyouthinthejuvenilejusticesystemhaveadiagnosablementaldisorder.88

Sexual Orientation

Socialattitudesregardingsexualorientationcanalsoimpacthowweviewpeoplewithmentalhealthproblems:

• Therejectionoflesbian,gay,bisexual,andtransgender(LGBT)youthbytheirfamilies,orbytheirpeersandcommunity,canhaveprofoundandlong-termimpacts,includingdepression,useofillegaldrugs,andsuicidalbehavior.89


Session 3: Focusing on YouthHow Can We Best Support the Mental Health of Young People?

Young people experience some of the highest prevalence rates of mental illness and yet have some of the lowest help seeking rates of any group. Additionally, childhood emotional and behavioral disorders are the most costly of all illnesses in children and youth.

Early Life Experiences

Earlylifeexperiencesareimportantinshapinganindividual’slifeintoadulthoodandcanimpacthowanindividuallearnsandrespondstostressfulevents.90

• Whenyoungchildrenareexposedtorepeatedtraumaticexperiences(e.g.,childabuse,witnessingviolence),theyareatincreasedriskofdevelopingmentalhealthproblems,substanceabuse,andchronichealthproblems(likeheartdiseaseanddiabetes).91

• Thenegativeimpactsoftheseearlyexperiences(sometimesreferredtoas“toxicstress”)canbepreventedorreversedwhenachildhasarelationshipwithasupportive,responsive,andcaringadultatanearlyage.92

• AdverseChildhoodExperiences,orACEs,isatermthatdescribesalltypesofabuse,neglect,andothertraumaticexperiencesthatoccurtoindividualsundertheageof18.Thesecanhaveaprofoundimpactonthatchild’sfuturehealth.Infact,apersonwhoexperiencesfourormoreACEswere7.4timesmorelikelytoconsiderthemselvesalcoholics,3.9timesmorelikelytohavechronicbronchitisoremphysema,4.6timesmorelikelytoreportbeingdepressed,and1.9timesmorelikelytodevelopcancer.93

Schools Play an Important Role

Schoolsplayacriticalroleinensuringthatbehavioralproblemsareidentifiedearlysothatyoungpeoplecangrowandthriveinahealthyenvironment.Schoolscanleadcoordinationeffortsinbringingyouth-servingagenciestogethertoguaranteethatchildren,youth,andfamiliescaneasilyaccessservicesthatarecommunitybased,childcentered,familyfocused,andculturallyandlinguisticallycompetent.

• Childrenwhohavenotdevelopedsocialandemotionalskillsbythetimetheyenterschoolareatadisadvantage.Forexample,childrenneedtobeabletopayattention,respondappropriatelytodirections,interactpositivelywithpeersandadults,andcontroltheiremotionsandbehaviorsinschoolinordertobesuccessful.95

Early Childhood Experiences Help Build Success Later in LifeChildren begin developing social and emotional skills at a very young age, and these skills form an important foundation for being able to succeed in school, in relationships, and in life.94

Did You Know?


• Studentswithpoorsocialskillsaremorelikelyto:experiencedifficultiesininterpersonalrelationshipswithteachersandpeers;showsignsofdepression,aggression,oranxiety;demonstratepooracademicperformance;andhaveahigherincidenceofinvolvementinthecriminaljusticesystemasadults.96

• Withoutadequatetreatment,youngadultsincollegewithamentalillnessaremorelikelytoreceivelowerGPAs,dropoutofcollege,orbeunemployedthantheirpeerswhodonothaveamentalhealthchallenge.97Thirty-onepercentofcollegestudentshavefounditdifficulttofunctionduetodepressioninthepastyear,whilemorethan50percenthavefeltoverwhelminganxiety,makingithardtosucceedacademically.98

• Approximately50percentofstudentsage14andolderwithamentalillnessdropoutofhighschool.Thisisthehighestdropoutrateofanydisabilitygroup.99

Leftuntreated,childhoodmentalandemotionaldisorderscanleadtopooroutcomesinschool,limitedemploymentopportunities,andothernegativeeconomicimpactsinadulthood.

Early Onset of Mental and Substance Use Disorders

Mentalhealthproblemsoftenbeginatanearlyageandbecomemoresignificantduringadolescenceandyoungadulthood.

• Halfofadultmentalhealthproblemsbeginbeforeage14,andthree-quartersbeginbeforeage24.100

• In2007,8.2percentofadolescents,anestimated2.0millionyouthsaged12to17,experiencedatleastonemajordepressiveepisode.101

• Amongalladolescentswithmajordepressiveepisodesinthepastyear,nearlytwothirds(62.3percent)didnotreceivetreatmentfortheirdepression.8.4percentoffull-timecollegestudentsaged18to22experiencedmajordepressioninthepastyear.102

• Ofchildrenandyouthinneedofmentalhealthservices,75-80percentoftheseyouthdonotreceiveservices.103

Did you know? The importance of seeking

treatment earlyDelays in receiving treatment after the first onset of symptoms of schizophrenia or psychosis are found to be related to: poorer response to antipsychotic medications, presence of more severe symptoms, more frequent recurrences and hospitalizations, and higher suicide risk.104

Did You Know?


Suicide Prevention is Key

Fartoomanyofournation’syouthtaketheirownlives:

• Suicideisthethirdleadingcauseofdeathamongyouthages15-24.105

• Onesurveyfoundthatina12-monthperiod,almost13.8percentofhighschoolstudentshadseriouslyconsideredsuicide,10.9percentofhighschoolstudentshadmadeasuicideplan,and6.3percentofhighschoolstudentsattemptedsuicideatleastonce.106

• Oneoutofevery53highschoolstudents(1.9percent)reporthavingmadeasuicideattemptthatwasseriousenoughtobetreatedbyadoctororanurse.107

• Thetollamongsomegroupsisevenhigher.Forexample,thesuicidedeathrateamong15–19-year-oldAmericanIndian/AlaskaNativemalesistwoandone-halftimeshigherthantheoverallrateformalesinthatagegroup.108

• Suicidetoucheseveryone,butthereishelpandhopewhenindividuals,communities,andprofessionalsjoinforcestopreventsuicide.SeeSAMHSA’sPreventingSuicide:AToolkitforHighSchools(http://store.samhsa.gov/shin/content/SMA12-4669/SMA12-4669.pdf)andSAMHSA’sSuicidePreventionResourceCenter’sRolesinPreventingSuicide(http://www.sprc.org/basics/roles-suicide-prevention).

• Ifyouorsomeoneyoucareaboutisfeelingalone,hopeless,orisincrisis,callorchatwithcaringcounselorsattheNationalSuicidePreventionLifelineat1-800-273-TALK(8255)or(http://suicidepreventionlifeline.org/GetHelp/LifelineChat2.aspx).


Session 4: Community SolutionsWhat Steps Do We Want To Take In Our Community?

Whether you are part of a small group of concerned citizens or a community-wide planning process, you can start working on local ideas and can focus on identifying individual and community solutions.

Itisimportanttofirstidentifywhatmentalhealthresourcescurrentlyexistinthecommunityanddeterminewhatelseisneeded.Workwithcommunitymemberstomapoutwhatpreventionstrategies,treatment,andrecoverysupportservicescurrentlyexistandhowtheyaremeetingtheneedsofthoseserved.

Aperson’smentalhealthcanbeaffectedbymanyelementsofoursociety.Theplaceswhereindividualsandcommunitieschoosetofocustheireffortscanbemuchbroaderthanmanypeoplemightthink.Forcommunities,itisdifficulttoknowwheretostartsincethetopicinvolvesschools,humanservices,providernetworks,families,neighborhoods,faithcommunities,andmanyotherstakeholders.

Thefollowingarealistofcommunityfactorsthatcanimpactmentalhealth.109

• Culturalnorms–suchasalcoholuse,bullying• Discrimination• Employmentopportunity• Foodinsecurity–notknowingwhereyournextmealwillcomefrom• Housingquality• Incomeinequality• Neighborhoodconditions• Physicalisolation• Publicservices• Socialstatus• Accesstohealthservices

Getting the Facts About What Works

Toassistwithcommunityplanningandimplementation,thereareavarietyofresourcestoidentifyeffectiveapproachestomeetthementalhealthneedsofyoungpeople.Whenchoosingevidence-basedapproaches,itisimportanttoidentifyandprioritizetheneedsofyoungpeopleinthecommunitysothatyoucandeterminewhichtypeofintervention,strategy,orapproachwillbethemostappropriate.110Itisalsoimportanttoassessthecommunity’scapacity(e.g.,financialresources,organizationalcommitment,communitybuy-in)toimplementanintervention,strategy,orapproachwhilepreservingthecomponentsthatmadetheoriginalpracticeeffective.111Communitiescanworktogethertodecidewhatinterventions,strategiesandapproachesmatchtheneedsofyoungpeopleinthecommunityandcanbeimplementedwithinthecommunity’scapacity.

For more information on evidence-based practices, refer to Appendix 1, “Helpful Resources and Websites.”


Additional Suggestions for Community Planning

Tailor your efforts to your community.Everycommunityisdifferentwhenitcomestodevelopingthenextstepsinsupportingourchildren,youth,andfamilies.

Celebrate what has been done in your community to strengthen mental health.Everycommunityisstartingfromauniquepointwithexistingassetsandresources.Itisimportanttocelebratethethingsthatarealreadytakingplaceinyourcommunity.

Highlight what work still needs to be done.Therewillalwaysbemoretodotosupportthehealthydevelopmentofyoungpeople.Taketimetorecognizehoweveryoneinthecommunitycanpitchinandsupportmentalhealth.

Describe what direction you plan to take as a community.Createavisionforhowyourcommunitywilladdressthementalhealthneedsofyouthandfamilies.

Keep working together.Effectiveeffortstoaddressmentalhealthrequiretheneedtoformandsustainpartnershipsfrommanydifferentpartsofthecommunity.Communityconversationmeetingsshouldbeconsideredjustthestartofanon-goingdialoguetoplan,implement,andevaluateefforts.

For more information you could use to host a conversation in your community, please go to www.CreatingCommunitySolutions.org and refer to Appendix 1, “Helpful Resources and Websites.”

(These materials and links are offered for informational purposes only and should not be construed as an endorsement of the referenced organization’s programs or activities.)


Appendix 1: Helpful Resources and Websites (Note: These organizations, materials and links are offered for informational purposes only and should not be construed as an endorsement of the referenced organization’s programs or activities.)

••

••

•

•

•

•

•

••••

••

••

•

•

•

••

•

•

•

••••

Resources• InformationAboutMentalHealth • http://www.MentalHealth.gov• SubstanceAbuseandMentalHealthServicesAdministration(SAMHSA) • http://www.SAMHSA.gov• NationalInstituteofMentalHealth(NIMH) • http://www.nimh.nih.gov• Additionalinformationyoucouldusetohostaconversationinyour

community• http://www.CreatingCommunitySolutions.org

Promoting Mental Health and Preventing Mental IllnessSuicidePreventionResourceCenter http://www.sprc.orgTheInstituteofMedicine’sPreventing Mental, Emotional and Behavioral Disorders Among Young People:ProgressandPossibilities

http://www.iom.edu/Reports/2009/Preventing-Mental-Emotional-and-Behavioral-Disorders-Among-Young-People-Progress-and-Possibilities.aspx

Addressingbullying http://www.stopbullying.govNationalCenterforMentalHealthPromotionandYouthViolencePrevention http://www.promoteprevent.org

FindYouthInfo http://www.findyouthinfo.gov

MillionHearts http://millionhearts.hhs.gov/index.html

Addressing Public AttitudesResourceCentertoPromoteAcceptance,Dignity,andSocialInclusion •

••

http://promoteacceptance.samhsa.gov

VoiceAwards http://www.samhsa.gov/voiceawardsChildren’sMentalHealthAwarenessDay http://www.samhsa.gov/children

Evidence-Based Practices for TreatmentNationalRegistryforEvidence-BasedProgramsandPractices http://www.nrepp.samhsa.gov

NationalCenterforTrauma-InformedCare http://www.samhsa.gov/nctic

Children’sMentalHealthInitiativeTechnicalAssistanceCenter http://www.cmhnetwork.org

Recovery Support ServicesNationalConsumerTechnicalAssistanceCenters http://ncstac.org/index.phpHomelessResourceCenter http://www.homeless.samhsa.govSharedDecisionMakinginMentalHealthTools http://162.99.3.211/shared.aspCollegeDrinking:ChangingtheCulture http://www.collegedrinkingprevention.gov

http://www.MentalHealth.gov

http://www.SAMHSA.gov

http://www.nimh.nih.gov/

http://www.CreatingCommunitySolutions.org

http://www.sprc.org




http://www.stopbullying.gov

http://www.promoteprevent.org

http://www.findyouthinfo.gov

http://millionhearts.hhs.gov/index.html

http://promoteacceptance.samhsa.gov/

http://www.samhsa.gov/voiceawards/

http://www.samhsa.gov/children

http://www.nrepp.samhsa.gov

http://www.samhsa.gov/nctic/

http://www.cmhnetwork.org

http://ncstac.org/index.php

http://www.homeless.samhsa.gov

http://162.99.3.211/shared.asp

http://www.collegedrinkingprevention.gov

20Community Conversat ions About Menta l Hea l th

Appendix 2: Acknowledgments NumerouspeoplecontributedtothedevelopmentoftheToolkitforCommunityConversationsonMentalHealth.WewouldliketoacknowledgetheSAMHSAstaff,workgroup,andinternswhocontributedtothecontentdevelopmentandeditofthistoolkit.

Wewouldliketothankthefederalagenciesthatassistedwiththecontentdevelopmentandreviewofthispublication:U.S.DepartmentofHealthandHumanServices(HHS),OfficeoftheSecretary;HHS,OfficeoftheAssistantSecretaryforPublicAffairs;theCentersforDiseaseControlandPrevention;theNationalInstituteofMentalHealth;theNationalInstituteonDrugAbuse;theNationalInstituteonAlcoholAbuseandAlcoholism;theHealthResourcesandServicesAdministration;theU.S.DepartmentofEducation;andtheU.S.DepartmentofJustice,OfficeofJuvenileJusticeandDelinquencyPrevention.

WealsoacknowledgetheNationalInstituteforCivilDiscourse,EverydayDemocracy,AmericaSpeaks,NationalIssuesForums,NationalCoalitionforDialogueandDeliberation,andtheDeliberativeDemocracyConsortiumfortheircontributionstothecontentofthispublication.


Reference List 1. WorldHealthOrganization.(2001).StrengtheningMentalHealthPromotion(Factsheetno.220).

Geneva:WorldHealthOrganization.Retrievedfromhttps://apps.who.int/inf-fs/en/fact220.html

2. Ibid.

3. Ibid.

4. SubstanceAbuseandMentalHealthServicesAdministration.(2013).DefinitionsofTraumaandResilience.Retrievedfromhttp://www.samhsa.gov/children/trauma-resilience-definitions.asp

5. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).NationalPreventionWeekParticipantToolkit(HHSPublicationNo.(SMA)12-4687).Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration.

6. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).SAMHSA’sWorkingDefinitionofRecovery(HHSPublicationNo.PEP12-RECDEF).Rockville,MD.Retrievedfromhttp://store.samhsa.gov/product/SAMHSA-s-Working-Definition-of-Recovery/PEP12-RECDEF

7. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2009).GuidingPrinciplesandElementsofRecovery-OrientedSystemsofCare:WhatDoWeKnowFromtheResearch?(HHSPublicationNo.(SMA)09-4439).Rockville,MD:CenterforSubstanceAbuseTreatment.Retrievedfromhttp://partnersforrecovery.samhsa.gov/docs/Guiding_Principles_Whitepaper.pdf

8. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).NationalPreventionWeekParticipantToolkit(HHSPublicationNo.(SMA)12-4687).Rockville,MD:CenterforSubstanceAbusePrevention,SubstanceAbuseandMentalHealthServicesAdministration.

9. Ibid.

10. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).Traumadefinition.Retrievedfromhttp://www.samhsa.gov/traumajustice/traumadefinition/definition.aspx

11. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:MentalHealthFindings(NSDUHSeries,H-45,HHSPublicationNo.(SMA)12-4725).Rockville,MD.Retrievedfromhttp://www.samhsa.gov/data/NSDUH/2k10MH_Findings/2k10MHResults.htm

12. U.S.DepartmentofHealthandHumanServices.(2013).WhatIsMentalHealth?Retrievedfromhttp://www.mentalhealth.gov/basics/what-is-mental-health/index.html

13. U.S.DepartmentofHealthandHumanServices.(2013).WhattoLookFor?Retrievedfromhttp://www.mentalhealth.gov/what-to-look-for/index.html

14. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2008).ResultsFromthe2007NationalSurveyonDrugUseandHealth:NationalFindings.(DHHSPublicationNo.(SMA)08-4343).Rockville,MD:OfficeofAppliedStudies,SubstanceAbuseandMentalHealthServicesAdministration.Retrievedfromhttp://www.samhsa.gov/data/nsduh/2k7nsduh/2k7results.pdf

15. NationalInstituteofMentalHealth.(2013).Psychotherapies.Bethesda,MD.Retrievedfromhttp://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml.

16. Ibid.

17. NationalInstituteofMentalHealth.(2013).MentalHealthMedications.Bethesda,MD.Retrievedfromhttp://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml.

18. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).SAMHSA’sWorkingDefinitionofRecovery(HHSPublicationNo.PEP12-RECDEF).Rockville,MD.Retrievedfromhttp://store.samhsa.gov/product/SAMHSA-s-Working-Definition-of-Recovery/PEP12-RECDEF

19. Smith,T.W.,Marsden,P.,Hout,M.,&Kim,J.(2011).GeneralSocialSurvey,1972-2010[machine-readabledatafileandcodebook].Storrs,CT:TheRoperCenterforPublicOpinionResearch,UniversityofConnecticut/AnnArbor,MI:Inter-universityConsortiumforPoliticalandSocialResearch[distributors].Retrievedfromhttp://dx.doi.org/10.3886/ICPSR31521.v1.


20. Pescosolido,B.,Martin,J.,Link,B.,Kikuzawa,S.,Burgos,G.,Swindle,R.,etal.(2000).Americans’ViewsofMentalHealthandIllnessatCentury’sEnd:ContinuityandChange.PublicreportontheMacArthurMentalHealthModule,1996GeneralSocialSurvey.Bloomington,Indiana:IndianaConsortiumforMentalHealthServicesResearchandJosephPMailmanSchoolofPublicHealth,ColumbiaUniversity.

21. Monahan,J.,Steadman,H.,Silver,E.,Appelbaum,P.,Robbins,P.,Mulvey,E.,etal.(2001).RethinkingRiskAssessment:TheMacArthurStudyofMentalDisorderandViolence.NewYork:OxfordUniversityPress.

22. Appelbaum,P.&Swanson,J.(2010).Law&Psychiatry:GunLawsandMentalIllness:HowSensibleAretheCurrentRestrictions?PsychiatricServices,61(7),652-654.

23. Teplin,L.,McClelland,G.,Abram,K.,&Weiner,D.(2005).Crimevictimizationinadultswithseverementalillness:ComparisonwiththeNationalCrimeVictimizationSurvey.ArchivesofGeneralPsychiatry,62(8),911-921.doi:10.1001/archpsyc.62.8.911.

24. CentersforDiseaseControlandPrevention,SubstanceAbuseandMentalHealthServicesAdministration,NationalAssociationofCountyBehavioralHealth&DevelopmentalDisabilityDirectors,NationalInstituteofMentalHealth,&TheCarterCenterMentalHealthProgram.(2012).AttitudesTowardMentalIllness:ResultsfromtheBehavioralRiskFactorSurveillanceSystem.Atlanta,GA:CentersforDiseaseControlandPrevention.

25. Ibid.

26. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2004).BuildingBridges:MentalHealthConsumersandMembersofFaith-BasedandCommunityOrganizationsinDialogue(DHHSPub.No.3868).Rockville,MD:CenterforMentalHealthServices,SubstanceAbuseandMentalHealthServicesAdministration.

27. U.S.DepartmentofHealthandHumanServices.(2001).MentalHealth:Culture,Race,andEthnicity—ASupplementtoMentalHealth:AReportoftheSurgeonGeneral.Rockville,MD:CenterforMentalHealthServices.

28. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2013).InfusingCulturalCompetencyintotheSPF.Rockville,MD:CenterforSubstanceAbusePrevention,SubstanceAbuseandMentalHealthServicesAdministration.Retrievedfrom:http://captus.samhsa.gov/prevention-practice/strategic-prevention-framework/cultural-competence/elements-culture

29. U.S.DepartmentofHealthandHumanServices.(2001).MentalHealth:Culture,Race,andEthnicity—ASupplementtoMentalHealth:AReportoftheSurgeonGeneral.Rockville,MD:CenterforMentalHealthServices.

30. Ibid.

31. Kessler,R.,McGonagle,K.,Zhao,S.,Nelson,C.,Hughes,M.,Eshleman,S.,etal.(1994).Lifetimeand12-monthPrevalenceofDSM-III-RPsychiatricDisordersintheUnitedStates:ResultsfromtheNationalComorbiditySurvey.ArchivesofGeneralPsychiatry,51(1),8-19.

32. U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention.(2010).TenLeadingCausesofInjuryDeathsbyAgeGroupHighlightingViolence-RelatedInjuryDeaths.Atlanta,GA:NationalCenterforInjuryPreventionandControl.Retrievedfromhttp://www.cdc.gov/injury/wisqars/pdf/10LCID_Violence_Related_Injury_Deaths_2010-a.pdf

33. Harding,C.,Brooks,G.,Ashikaga,T.,Strauss,J.S.,&Breier,A.(1987).TheVermontlongitudinalstudyofpersonswithseverementalillness.AmericanJournalofPsychiatry,144(6),727–735.

34. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2009).2009CMHSUniformReportingSystemoutputtables.Retrievedfromhttp://www.samhsa.gov/dataoutcomes/urs/urs2009.aspx

35. Cook,J.,Leff,H.,Blyler,C.,Gold,P.,Goldberg,R.,Mueser,K.,etal.(2005).Resultsofamultisiterandomizedtrialofsupportedemploymentinterventionsforindividualswithseverementalillness.ArchivesofGeneralPsychiatry,62(5),505–512.

36. Davis,K.(2012).StatisticalBrief#358:ExpendituresforTreatmentofMentalHealthDisordersamongYoungAdults,Ages18-26,2007-2009:EstimatesfortheU.S.CivilianNoninstitutionalizedPopulation.Rockville,MD:MedicalExpendituresPanelSurvey,AgencyforHealthcareResearchandQuality.


37. UnitedStatesGovernmentAccountabilityOffice.(2008).YoungAdultswithSeriousMentalIllness:SomeStatesandFederalAgenciesAreTakingStepstoAddressTheirTransitionChallenges(ReporttoCongressionalRequestors,GAO-08-678).Retrievedfromhttp://www.gao.gov/new.items/d08678.pdf

38. Kessler,R.,Heeringa,S.,Lakoma,M.,Petukhova,M.,Rupp,A.,Schoenbaum,M.,etal.(2008).Theindividual-levelandsocietal-leveleffectsofmentaldisordersonearningsintheUnitedStates:ResultsfromtheNationalComorbiditySurveyReplication.AmericanJournalofPsychiatry,165(6),703-11.doi:10.1176/appi.ajp.2008.08010126.

39. Miller,T.&Hendrie,D.(2008).SubstanceAbusePreventionDollarsandCents:ACost-BenefitAnalysis(DHHSPub.No.(SMA)07-4298).Rockville,MD:CenterforSubstanceAbusePrevention,SubstanceAbuseandMentalHealthServicesAdministration.

40. Ibid.

41. Ibid.

42. Ibid.

43. U.S.DepartmentofHousingandUrbanDevelopment.(2011).The2010AnnualHomelessAssessmentReporttoCongress(HUDNo.11-121).Retrievedfromhttps://www.onecpd.info/resources/documents/2010homelessassessmentreport.pdf;Folsom,D.,Hawthorne,W.,Lindamer,L.,et.al.(2005).Prevalenceandriskfactorsforhomelessnessandutilizationofmentalhealthservicesamong10,340patientswithseriousmentalillnessinalargepublicmentalhealthsystem.AmericanJournalofPsychiatry,162(2),370-376.

44. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:SummaryofNationalFindings(NSDUHSeriesH-44,HHSPublicationNo.(SMA)12-4713).Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration

45. Ibid.

46. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:MentalHealthFindings.(NSDUHSeriesH-45,HHSPublicationNo.(SMA)12-4725).Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration.

47. Ibid.

48. U.S.DepartmentofHousingandUrbanDevelopment.(2011).The2010AnnualHomelessAssessmentReporttoCongress(HUDNo.11-121).Retrievedfromhttps://www.onecpd.info/resources/documents/2010homelessassessmentreport.pdf

49. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2005).SubstanceAbuseTreatmentforPersonsWithCo-OccurringDisorders.TreatmentImprovementProtocol(TIPSeries42,DHHSPublicationNo.(SMA)12-3992).Rockville,MD.Retrievedfromhttp://www.ncbi.nlm.nih.gov/books/NBK64197/pdf/TOC.pdf;PolcinD.&Henderson,D.M.(2008).Acleanandsoberplacetolive:philosophy,structure,andpurportedtherapeuticfactorsinsoberlivinghouses.JournalofPsychoactiveDrugs,40(2),153-159;Hannigan,T.,&Wagner,S.(2003).Developingthe“Support”inSupportiveHousing:AGuidetoProvidingServicesinHousing.RetrievedfromCorporationforSupportiveHousingwebsiteathttp://documents.csh.org/documents/pubs/DevelopingSupport-full.pdf;Larimer,M.E.,etal.(2009).Healthcareandpublicserviceuseandcostsbeforeandafterprovisionofhousingforchronicallyhomelesspersonswithseverealcoholproblems.JournaloftheAmericanMedicalAssociation,301(13),1349–1357.

50. Culhane,P.,Metraux,S.,&Hadley,T.(2002).Publicservicereductionassociatedwithplacementofhomelesspersonswithseverementalillnessinsupportivehousing.HousingPolicyDebate,13(1),107-163.

51. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2010).PermanentSupportiveHousing:BuildingYourProgram(HHSPub.No.SMA-10-4509).Rockville,MD:CenterforMentalHealthServices.

52. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:MentalHealthFindings(NSDUHSeries,H-45,HHSPublicationNo.(SMA)12-4725).Rockville,MD.Retrievedfromhttp://www.samhsa.gov/data/NSDUH/2k10MH_Findings/2k10MHResults.htm

53. U.S.DepartmentofEducation.(2001).Twenty-thirdannualreporttoCongressontheimplementationoftheIndividualswithDisabilitiesEducationAct.Washington,D.C.:U.S.DepartmentofEducation.


54. Druss,B.(2011).UnderstandingExcessMortalityinPersonswithMentalIllness.MedicalCare,49(6),599-604.

55. Copeland,W.,Wolke,D.,Angold,A.,&Costello,E.(2013).AdultPsychiatricOutcomesofBullyingandBeingBulliedbyPeersinChildhoodandAdolescence.JAMAPsychiatry,70(4),419-426.

56. Miller,T.,&Hendrie,D.(2008).SubstanceAbusePreventionDollarsandCents:ACost-BenefitAnalysis(DHHSPub.No.(SMA)07-4298).Rockville,MD:CenterforSubstanceAbusePrevention,SubstanceAbuseandMentalHealthServicesAdministration.

57. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:SummaryofNationalFindings(NSDUHSeriesH-44,HHSPublicationNo.(SMA)12-4713).Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration.

58. Ibid.

59. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).PromotingRecoveryandResilienceforChildrenandYouthInvolvedintheJuvenileJusticeandChildWelfareSystems.Rockville,MD:CenterforMentalHealthServices,SubstanceAbuseandMentalHealthServicesAdministration.

60. Ibid.

61. Ibid.

62. DepartmentofHealth.(2001).Makingithappen:aguidetodeliveringmentalhealthpromotion.London,UK.Retrievedfromhttp://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4007907

63. NationalFederationofFamiliesforChildren’sMentalHealth.(2013).DefinitionofFamily-DrivenCare.Retrievedfromhttp://ffcmh.org/family-driven-definition

64. U.S.DepartmentofLabor,EmployeeBenefitsSecurityAdministration.(2010).YoungAdultsandtheAffordableCareAct:ProtectingYoungAdultsandEliminatingBurdensonFamiliesandBusinesses.Washington,DC.Retrievedfromhttp://www.dol.gov/ebsa/pdf/fsdependentcoverage.pdf;Lotstein,D.,Inkelas,M.,Hays,R.,Halfon,N.,Brook,R.(2008).AccesstoCareforYouthwithSpecialHealthCareNeedsintheTransitiontoAdulthood.JournalofAdolescentHealth,43(1),23-29.

65. Millstein,S.,&Halpern-Felsher,B.(2001).PerceptionsofRiskandVulnerability.InFischhoff,B.,Nightingale,E.,&Iannotta,J.(Eds.)AdolescentRiskandVulnerability:ConceptsandMeasurement.(pp.15-29).Retrievedfromhttp://www.nap.edu/openbook.php?record_id=10209&page=15

66. U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention.(2010).NationalVitalStatisticsSystem,NationalCenterforHealthStatistics.Web-basedInjuryStatisticsQueryandReportingSystem(WISQARS)[online].Retrievedfromhttp://www.cdc.gov/injury/wisqars/pdf/10LCID_All_Deaths_By_Age_Group_2010-a.pdf

67. Embry,L.,VanderStoep,A.,Evens,C.,Ryan,K.,Pollack,A.(2000).Riskfactorsforhomelessnessinadolescentsreleasedfrompsychiatricresidentialtreatment.JournaloftheAmericanAcademyofChild&AdolescentPsychiatry,39(10),1293-9.

68. Davis,M.,Banks,S.,Fisher,W.,Gershenson,B.,Grudinskas,A.(2007).Arrestsofadolescentclientsofapublicmentalhealthsystemduringadolescenceandyoungadulthood.PsychiatricSercices,58(11),1454-60.

69. U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention.(2013).MentalHealthSurveillanceAmongChildren—UnitedStates,2005–2011.MMWR,62(02),1-35.Retrievedfromhttp://www.cdc.gov/mmwr/preview/mmwrhtml/su6202a1.htm?s_cid=su6201a2_w

70. U.S.DepartmentofEducation,NationalCenterforEducationStatistics.(2008)TheConditionofEducation2008(NCESPub.No.2008-031).Washington,DC.Retrievedfromhttp://www.eric.ed.gov/PDFS/ED501487.pdf

71. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2003).OverviewofFnidingsfromthe2002NationalSurveyonDrugUseandHealth(NHSDASeriesH-22,DHHSPublicationNo.(SMA)03-3836).Retrievedfromhttp://samhsa.gov/data/NHSDA/2k2NSDUH/2k2SoFOverviewW.pdf;Neinstein,L.(2013).TheNewAdolescents:Ananalysisofhealthconditions,behaviors,risksandaccesstoservicesamongemergingyoungadults.Retrievedfromhttp://www.usc.edu/student-affairs/Health_Center/thenewadolescents/doc/TheNewAdolescents_Final_Locked.pdfaffairs/Health_Center/thenewadolescents/doc/TheNewAdolescents_Final_Locked.pdf


72. Davis,M.,&VanderStoep,A.(1997).Thetransitiontoadulthoodforyouthwhohaveseriousemotionaldisturbance:DevelopmentalTransitionandyoungadultoutcomes.JournalofMentalHealthAdministration,24(4),400-426.

73. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).DataSpotlight:FewerthanOneinEightAdolescentSubstanceAbuseTreatmentAdmissionsAreReferredtoTreatmentbySchools.Rockville,MD:CenterforBehavioralHealthQualityandStatistics,SubstanceAbuseandMentalHealthServicesAdministration.Retrievedfromhttp://www.samhsa.gov/data/spotlight/Spot057EduReferrals2012.pdf

74. Ibid.

75. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:MentalHealthFindings(NSDUHSeries,H-45,HHSPublicationNo.(SMA)12-4725).Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration.Retrievedfromhttp://www.samhsa.gov/data/NSDUH/2k10MH_Findings/2k10MHResults.htm

76. Kataoka,S.,Zhang,L.,&Wells,K.(2002).UnmetNeedforMentalHealthCareAmongU.S.Children:Variationbyethnicityandinsurancestatus.AmericanJournalPsychiatry,159(9),1548-55.doi:10.1176/appi.ajp.159.9.1548.

77. NationalAllianceonMentalIllness.(2010).MentalIllnessandtheWorkplace.Arlington,VA.Retrievedfromhttp://www.nami.org/Content/NavigationMenu/State_Advocacy/About_the_Issue/Workplace.pdf

78. Culhane,P.,Metraux,S.,&Hadley,T.(2002).Publicservicereductionassociatedwithplacementofhomelesspersonswithseverementalillnessinsupportivehousing.HousingPolicyDebate,13(1);U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2010).PermanentSupportiveHousing:BuildingYourProgram(HHSPub.No.SMA-10-4509).Rockville,MD:CenterforMentalHealthServices,SubstanceAbuseandMentalHealthServicesAdministration.

79. Eisenberg,D.,&Neighbors,K.(2007).EconomicsofPreventingMentalDisordersandSubstanceAbuseAmongYoungPeople.PapercommissionedbytheCommitteeonPreventionofMentalDisordersandSubstanceAbuseAmongChildren,Youth,andYoungAdults.Washington,DC:ResearchAdvancesandPromisingInterventions,BoardonChildren,Youth,andFamilies,NationalResearchCouncilandInstituteofMedicine.

80. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2011).TheNSDUHReport:SourcesofPaymentforMentalHealthTreatmentforAdults.Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration.

81. Ibid.

82. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2010).NationalExpendituresforMentalHealthServicesandSubstanceAbuseTreatment,1986-2005(DHHSPublicationNo.(SMA)10-4612).Rockville,MD:CenterforMentalHealthServicesandCenterforSubstanceAbuseTreatment,SubstanceAbuseandMentalHealthServicesAdministration.

83. Beronio,K.,Po,R.,Skopec,L.,&Glied,S.(2013).AffordableCareActExpandsMentalHealthandSubstanceUseDisorderBenefitsandFederalParityProtectionsfor62MillionAmericans.Washington,D.C.:OfficeoftheAssistantSecretaryforPlanningandEvaluation,U.S.DepartmentofHealthandHumanServices.Retrievedfrom:http://aspe.hhs.gov/health/reports/2013/mental/rb_mental.cfm

84. Appelbaum,P.&Swanson,J.(2010).Law&Psychiatry:GunLawsandMentalIllness:HowSensibleAretheCurrentRestrictions?PsychiatricServices,61(7),652-654.

85. Teplin,L.A.,McClelland,G.M.,Abram,K.M.,&Weiner,D.A.(2005).CrimeVictimizationinAdultsWithSevereMentalIllness:Comparisonwiththenationalcrimevictimizationsurvey.ArchivesofGeneralPsychiatry,62(8),911-921.

86. Judge,D.L.(2005).FactSheet#3:IndividualswithMentalIllnessesinJailandPrison.Retrievedfromhttp://data.opi.mt.gov/bills/2005/Minutes/House/Exhibits/jhh14a200.pdf

87. U.S.DepartmentofJustice,OfficeofJusticePrograms.(2006).BureauofJusticeStatisticsspecialreport:mentalhealthproblemsandjailinmates(NCJ213600).Retrievedfromhttp://bjs.ojp.usdoj.gov/content/pub/pdf/mhppji.pdf


88. Skowyra,K.,&Cocozza,J.(2006).BlueprintforChange:AComprehensiveModelfortheIdentificationandTreatmentofYouthwithMentalHealthNeedsinContactwiththeJuvenileJusticeSystem.Delmar,NY:TheNationalCenterforMentalHealthandJuvenileJusticeandPolicyResearchAssociates,Inc.

89. Ryan,C.,Huebner,D.,Diaz,R.M.,&Sanchez,J.(2009).FamilyRejectionasaPredictorofNegativeHealthOutcomesinWhiteandLatinoLesbian,Gay,andBisexualYoungAdults.Pediatrics,123(1),346–352.;NationalPreventionCouncil.(2011).NationalPreventionStrategy.Washington,DC:U.S.DepartmentofHealthandHumanServices,OfficeoftheSurgeonGeneral.

90. Gebhard,B.(2009).EarlyLifeExperiencesMatter:AGuidetoImprovedPoliciesforInfantsandToddlers.Washington,D.C.:ZerotoThree.Retrievedfromhttp://main.zerotothree.org/site/DocServer/Policy_Guide.pdf?docID=8401

91. Perry,B.,Pollard,R.,Blakley,T.,Baker,W.,&Vigilante,D.(1995).ChildhoodTrauma:TheNeurobiologyofAdaptationand‘Use-Dependent’DevelopmentoftheBrain.InfantMentalHealthJournal,16(4),271–291.

92. CenterontheDevelopingChild,HarvardUniversity.(2008).InBrief:TheScienceofEarlyChildhoodDevelopment.Boston,MA:NGACenterforBestPractices,NationalConferenceofStateLegislatures,andCenterontheDevelopingChild,HarvardUniversity.Retrievedfromhttp://developingchild.harvard.edu/index.php/resources/briefs/inbrief_series/inbrief_the_science_of_ecd/

93. Felitti,V.J.,Anda,R.F.,Nordenberg,D.,Williamson,D.F.,Spitz,A.M.,Edwards,V.,etal.(1998).RelationshipofChildhoodAbuseandHouseholdDysfunctiontoManyoftheLeadingCausesofDeathinAdults:TheAdverseChildhoodExperiences(ACE)Study.AmericanJournalofPreventiveMedicine,14(4),245-258.

94. Ladd,G.,Birch,S.,&Buhs,E.(1999).Children’sSocialandScholasticLivesinKindergarten:RelatedSpheresofInfluence?ChildDevelopment,70(6):1373–1400.;Raver,C.(2002).EmotionsMatter:MakingtheCasefortheRoleofYoungChildren’sEmotionalDevelopmentforEarlySchoolReadiness.SocialPolicyReportoftheSocietyforResearchinChildDevelopment,16(1),3–23.

95. Raver,C.(2002).EmotionsMatter:MakingtheCasefortheRoleofYoungChildren’sEmotionalDevelopmentforEarlySchoolReadiness.SocialPolicyReportoftheSocietyforResearchinChildDevelopment,16(1),3–23.

96. NationalAssociationofSchoolPsychologists.(2002).SocialSkills:PromotingPositiveBehavior,AcademicSuccess,andSchoolSafety.Bethesda,MD.Retrievedfromhttp://www.nasponline.org/resources/factsheets/socialskills_fs.aspx

97. UnitedStatesGovernmentAccountabilityOffice.(2008).YoungAdultswithSeriousMentalIllness:SomeStatesandFederalAgenciesAreTakingStepstoAddressTheirTransitionChallenges(ReporttoCongressionalRequestors,GAO-08-678).Retrievedfromhttp://www.gao.gov/new.items/d08678.pdf

98. AmericanCollegeHealthAssociation.(2012).AmericanCollegeHealthAssociation-NationalCollegeHealthAssessmentII:ReferenceGroupExecutiveSummarySpring2012.Hanover,MD:AmericanCollegeHealthAssociation.Retrievedfromhttp://www.acha-ncha.org/docs/ACHA-NCHA-II_ReferenceGroup_ExecutiveSummary_Spring2012.pdf

99. U.S.DepartmentofEducation.(2001).Twenty-thirdannualreporttoCongressontheimplementationoftheIndividualswithDisabilitiesEducationAct.Washington,D.C.:U.S.DepartmentofEducation.

100. Kim-Cohen,J.,Caspi,A.,Moffitt,T.,Harrington,H.,Milne,B.,&Poulton,R.(2003).Priorjuvenilediagnosesinadultswithmentaldisorder:Developmentalfollow-backofaprospective-longitudinalcohort.ArchivesofGeneralPsychiatry,60(7),709-717.

101. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:MentalHealthFindings(NSDUHSeriesH-45,HHSPublicationNo.(SMA)12-4725).Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration.

102. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).DataSpotlight:MajorDepressiveEpisodeamongAdolescentsLivinginPoverty.Rockville,MD:CenterforBehavioralHealthQualityandStatistics.Retrievedfromhttp://www.samhsa.gov/data/spotlight/Spotlight_064_Poverty_2012/CBSHQ_Spotlight_064_Poverty_2012.pdf

103. Kataoka,S.,Zhang,L.,&Wells,K.(2002).UnmetneedsformentalhealthcareamongU.S.children:Variationbyethnicityandinsurancestatus.AmericanJournalofPsychiatry,159(9),1548-1555.


104. Dell’Osso,B.,Glick,I.,Baldwin,D.,&Altamura,A.(2013).CanLong-TermOutcomesBeImprovedbyShorteningtheDurationofUntreatedIllnessinPsychiatricDisorders?AConceptualFramework.Psychopathology,46(1),14-21.

105. U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention.(2010).NationalVitalStatisticsSystem,NationalCenterforHealthStatistics.Web-basedInjuryStatisticsQueryandReportingSystem(WISQARS)[online].Retrievedfromhttp://www.cdc.gov/injury/wisqars/pdf/10LCID_All_Deaths_By_Age_Group_2010-a.pdf

106. U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention.(2010).Youthriskbehaviorsurveillance—UnitedStates,2009.SurveillanceSummaries.MMWR,59(SS-5).

107. Ibid.

108. Heron,M.(2007).Deaths:Leadingcausesfor2004.NationalVitalStatisticsReports(l56-5).Hyattsville,MD:NationalCenterforHealthStatistics.Retrievedfromhttp://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_05.pdf

109. AdlerSchoolInstituteonSocialExclusion&AdlerSchoolInstituteonPublicSafetyandSocialJustice.(2011).Definingterms:Socialdeterminantsofmentalhealth.Intersections:ATransdisciplinaryExplorationofSocialIssues,6(4),9.

110. Ibid.;AdministrationforChildrenandFamilies.(2013).ChildWelfareInformationGateway,FidelityinEvidence-BasedPractice.Retrievedfromhttps://www.childwelfare.gov/management/practice_improvement/evidence/fidelity.cfm

111. SubstanceAbuseandMentalHealthServicesAdministration.(2013).SAMHSA’sNationalRegistryofEvidence-basedProgramsandPractices,FrequentlyAskedQuestions.Retrievedfromhttp://www.nrepp.samhsa.gov/FAQ.aspx


Notes:

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