By Tami Silverman, President & CEO, Indiana Youth Institute

An increasing number of our children and youth have mental health disorders, encountering challenges with school, within their peer groups, and at home. Unfortunately, most of them are not getting the care they need. Signs of mental health disorder may be difficult to recognize, and unfortunately mental health disorders continue to be stigmatized. These, combined with a lack of access to services for many, create substantive barriers to care. More must be done to combat widely-held myths, connect children with treatment, supports, and services, and work to build strong support networks for all our young people.

A February 2019 study in JAMA Pediatrics estimated that 7.7 million American children, one in every 6 children, have at least one mental health disorder. According to the Centers for Disease Control (CDC), ADHD, behavior problems, anxiety and depression are the most commonly diagnosed mental disorders in children, and some of these conditions, such as anxiety and depression, commonly occur together. The JAMA Pediatrics study also showed that roughly half of children do not receive any kind of treatment from a mental health professional.

Last year, 11.6% of Hoosier children received treatment or counseling from a mental health professional, a significant number, and yet still only a portion of Indiana children in need. The National Survey of Children’s Health indicates that 5.2% of Indiana children have ever been diagnosed with depression, and 11.0% have been diagnosed with anxiety. We know that accessibility remains an issue in Indiana. Among our neighboring states, Indiana has the lowest ratio of mental health providers available to serve the population, approximately 1 per every 700 people, and nearly 60% of the state’s population lives in designated mental health professional shortage areas.

Identifying mental health issues may be less obvious than physical ailments, such as broken bones, asthma, or diabetes. Occasional bouts with emotional distress, anxiety, stress, and depression are normal experiences for all children and youth. It can be difficult to distinguish between behaviors and emotions that are related to typical child development, and those that require extra attention and concern.

The national nonprofit Child Mind Institute describes seven myths about childhood mental illness that need to be debunked. These include recognizing that childhood mental illness is not caused by personal weakness or poor parenting. Children and youth cannot overcome mental health problems through willpower, nor will they grow out of their disorder. Instead, understanding that most psychiatric disorders begin before age fourteen provides additional incentive to screen and intervene during childhood. Children who receive early interventions and treatment have a good chance of managing or overcoming their symptoms.

How do you know when a child’s behavior is cause for concern? You should always seek immediate help for a child or teen who harms themselves or others or talks about wanting to do so. While short term stress, anxiety or depression can be developmentally appropriate, the National Institute of Health (NIH) advises that you should also seek help if a child’s behavior or emotional difficulties last more than a few weeks and are causing problems at school, at home or with their friends. Young children may exhibit symptoms such as intense worry or fear, frequent tantrums, complaints about frequent stomach or headaches with no known medical cause, and a lack of interest in playing with other children. Symptoms in teenagers include a loss of interest in previously enjoyable activities, spending increasing amounts of time alone or avoiding social activities, sleeping too little or too much, and engaging in risky, destructive or self-harming behaviors. The NIH recommends talking with your child’s teacher and consulting your pediatrician, asking either for a recommendation to a mental health professional who has specific experience in dealing with children, when and if possible.

Caring adults and a strong support network, including family members, teachers, coaches and mentors, can serve as protective factors for mental health. Indiana’s Family and Social Services Administration Division of Mental Health and Addiction manages our state’s Systems of Care, a model framework used to coordinate services and supports. Schools throughout the state continue to expand their services and expertise, understanding the importance of prevention, intervention, positive development, and communication to families.

While many agree that progress has been made regarding how mental health is viewed, stigma and negative connotations still keep far too many children from getting critical care and support. It is important to understand and work to reduce the barriers of stigma and access to mental health care. It is equally, if not more important, to understand that, for most youth, childhood mental disorders are episodic rather than permanent. Just as with physical illnesses, keys include ensuring children in need can receive appropriate screening and treatment. We would not ignore a child’s physical ailment, and it is time that we consistently take the same approach to their mental health.

(Tami Silverman is the President & CEO of the Indiana Youth Institute. She may be reached at iyi@iyi.org or on Twitter at @Tami_IYI. IYI’s mission is to improve the lives of all Indiana children by strengthening and connecting the people, organizations, and communities that are focused on kids and youth.)

Hoosier youth are the hidden victims of the opioid epidemic. The statewide crisis has a negative impact on child well-being, families and communities. Hoosiers are more likely to die from a drug overdose than car crashes and gun homicides combined. In 2017, Indiana’s rate of fatal overdoses was 25.7 per 100,000. This is significantly above the national average of 22.4, ranking Indiana’s overdose death rate as the 15th highest in the nation.

  • In 2017, 1,138 Hoosiers died from an opioid overdose, a rate of 17.1 deaths per 100,000 Indiana residents.
  • In 2016, opioid overdose deaths were most common among white (89.8%), followed by black (8.9%) and all other Hoosiers (1.3%).
  • 83 out of the 92 Indiana counties had at least one non-fatal emergency department visit involving any opioid in 2017.

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Indiana ranks 48th for child abuse and neglect which puts children’s safety at risk and impacts future well-being across a lifetime.

Reporting

The Indiana Child Abuse and Neglect Hotline serves as the central reporting center for child maltreatment allegations.

  • The total number of calls made to the Indiana Child Abuse an dNeglect Hotline in 2018 was 203,602, an increase of 30.6% since 2012.
  • In 2018, the Indiana Child Abuse and Neglect Hotline handled 242,994 reports; this has increased by 36.9% since 2012.
  • Every adult in the state of Indiana is a mandatory reporter of child abuse and neglect. Any adult who has reason to believe that a child has been abused or neglected is required to call the Department of Child Services: 1-800-800-5556.

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Hoosier youth health is threatened by the harmful effects of tobacco use. Youth vaping is on the rise and is associated with a likelihood of increasing the use of both e-cigarettes and cigarettes in the future.

Harmful Effects

The use of any type of tobacco product is unsafe for young people. Tobacco use is the leading cause of preventable disease in the United States. All types of tobacco products are harmful and any exposure to tobacco smoke can cause immediate and long-term damage.

  • 3,700 Hoosier children under 18 become new daily smokers each year.
  • Nearly 9 out of 10 smokers start before age 18.4• Youth are sensitive to nicotine addiction and feel dependence earlier than adults. Nicotine addiction prolongs tobacco use and leads to severe health consequences.
  • As the brain continues developing until age 25, adolescent use of e-cigarettes containing nicotine can harm the part of the brain responsible for mood, learning and impulse control.

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Complex and diverse challenges face our students, teachers and schools. While addressing and assessing student academic achievement is a top priority, preparation for success also includes attending to their mental and physical health. Schools are pushed to meet testing demands. With limited time and resources, districts may create room for academics by reducing recess. This short-term response may have long-term consequences for our students. Acknowledging that recess is critical to the well-being of our children challenges us to look beyond test scores to focus on the development of the whole child.

The physical benefits of recess are well established. It allows students to develop large motor skills, engage in sports and increase their activity levels, while encouraging them to choose and vary their active pursuits. Experts suggest the type of activity is less important than movement itself, noting that recess contributes to the recommended 60 minutes of daily activity.

Yet the benefits of recess extend beyond a child’s physical well-being. The American Academy of Pediatrics (AAP) says recess enhances cognitive, emotional and social development, while promoting communication, negotiation and problem-solving skills. It also provides a way for students to vent frustrations, anxiety and even anger in an appropriate setting. By being unstructured yet supervised, recess provides a unique setting for children to interact, test and develop the skills that aid their overall social growth.

In addition to the physical and social-emotional benefits, recess enhances academic outcomes. The AAP reports that following recess, students demonstrate increased focus and cognitive processing. The Robert Wood Johnson Foundation describes it as “an underutilized opportunity to improve the overall learning environment in our schools.”

Playworks Indiana is a best-in-class program that works with schools to maximize the benefits of recess. By using Playworks’ approach to inclusive, value-based recess, schools have decreased reports of bullying and increased student feelings of safety and security. A Stanford University study found using the Playworks model resulted in schools recapturing 24 hours of learning time each year.

Parents, school boards and lawmakers across the country are paying attention to the benefits of recess. Rhode Island now requires that elementary schools give children at least 20 minutes of recess each day. A Texas school district has adopted a policy providing elementary students four 15-minute recess breaks per day. Some Florida parents created a statewide advocacy network to protect and increase recess.

School recess is a sound investment that contributes to the physical, social, emotional and cognitive development of Hoosier children. This unstructured play creates lasting health benefits for our kids and helps them build life skills for future success. Recess is a serious educational strategy and we should all support its critical role in developing well-rounded, thoughtful, successful kids.

(Tami Silverman is the president and CEO of the Indiana Youth Institute. She may be reached at iyi@iyi.org or on Twitter at @Tami_IYI)