Teens' Mental Well-Being - Diagnosis, Treatment, and Service Gaps - Research Paper Example

Adolescents and Mental Health: Diagnosis, Treatment, and Service Gaps Introduction In 2003 Dr Ahmed Okasha was the president of the World Psychiatric Association and began the Global Program for Child and Adolescent Mental Health in order to focus on three elements: awareness, prevention, and treatment. The initiative was presented to fill the gaps in addressing the issues of child and adolescent mental health and to address the gaps in services that are provided for children and adolescents with mental disorders (Remschmidt, 2007). This paper proposes to focus on adolescence with the intention of further examining the gaps in mental healthcare for teenage patients in relationship to diagnosis, treatment, and available services. In addition, the differentiation between social issues and mental issues is addressed and the issues that come from lumping both types of mental issues into one category of care. Through mixed methodology research, both quantified evaluations and experiential evaluation will address the research questions in order to uncover answers that can fill in the gaps. Literature review Introduction The issues of mental illness in adolescents are often clouded where the line between social problems and mental disease is blurred through a misunderstanding of psychiatric disorders as they relate in the social sphere. The following literature review exams the issues of diagnosis, treatment, and service in relationship to defining the differences between social issues and mental issues. Defining Mental Problems Mental problems can be divided into two broad categories. The first category is mental illness in which the individual has a condition that may be affected by social issues, but is not cured by taking those issues out of the situation. The illness manifests through the individual’s mind and while it can be medicated in order to get the condition under control, it is not defined by external forces (Elder, Evans, & Nizette, 2009). Social problems are those which manifest because of the pressure of external forces. Loseke (2003) discusses that there are four primary concepts that must be considered when discussing social problems. The first is that social problems are not a category that is stable. The second factor is that the list of social problems is long and almost impossible to fully comprehend. The third aspect of social problems is that they are almost always based on social disagreements on behaviour, which is relevant to the problems that are often associated with adolescence as teenagers act in rebelling against social norms of behavior. The final concept that is associated with social issues is that they are conditions and about the people in those conditions (Loseke, 2003). In defining the difference between mental problems associated with social issues and those associated with disease, the difference is in between the external locus and the internal locus. While one side of mental illness promotes the idea that both types of locations of the illness result in mental health problems, another perspective suggests that while one should be medicated pharmacologically, the other should be addressed through coping skills rather than medicating situations as if they were illness (Freeth, 2007). Depression One of the most commonly diagnosed illnesses in adolescents is depression. According to research that is reported by Weiss (2008) adolescents in two individual research studies showed no significant difference in decreased depression when either treated with therapy and medications or only treated with therapy. In other words, the difference between being medicated and not being medicated was minimal where therapy with someone who would discuss their issues and address coping mechanisms was successful with or without medicated supplements. Depression can be observed through several forms through which some is defined for reactions to social issues while other forms are a part of illness that is not solved through social resolutions. Major Depressive Disorder or MDD is a clinical condition that affects 121 million people worldwide. The illness has been diagnosed in children as young as 5 and can be a lifelong condition affecting employment opportunities, interpersonal problems, substance abuse, and self-abuse (Springer, Rubin, & Beevers, 2011). Depression in children appears at an average rate of 1-2%, but increases significantly to about 8% in adolescents with the average course of the illness lasting 6-8 month with high evidence of reoccurrences in both adolescent and adulthood (Strauman, Costanzo, & Garber, 2011). Abela & Hankin (2008) discuss the differences in the experience of depression in male and female adolescents showing that the issues of being female in current society provide for a higher sense of vulnerability to depression than in male adolescents. This provides context for the idea that it is social pressure from an external locus that is often diagnosed as a mental illness rather than being supported through coping skills as a mental health issue. Social Issues and Coping Skills Perceptions and belief systems in adolescents are defined as they hover somewhere between childhood dependence on authority in combination with the supernatural and the logic of adulthood which comes with the acceptance of responsibilities and roles. As they begin to understand the world and accept the concept of responsible behavior, confusion often leads to mental health issues that require learning skills to cope with their newly defined world (Millstein, Peterson, & Nightingale, 1993). Even in clearly diagnosed mental illness, coping skills are an important aspect of meaningful interaction within the world. Haycock and Shaya (2009) discuss that when a schizophrenic diagnosis comes to a patient they are usually in formative years of socialization into the adult world at between the ages of 17-22. In order to treat the illness “symptom control, therapy, and practice (of social skills)” is required to achieve successful integration into the world (Haycock & Shaya, 2009, p. 7). Labeling adolescents with behavioral disorders often locks them into a framework of behavior while the condition is largely affected by an external locus. Although blaming parents is not necessary in adolescents with social disorders, providing context for how those disorders are manifesting is important for developing good treatment. Responsibility and coping skills in order to exist within an environment that is putting pressure on a child is essential to good mental health treatment. While pharmacological remedies often are used to facilitate better behavior, defining behavioral problems from mental health issues would be beneficial in reducing the number of adolescents that are medicated into socially ordered behaviors. Summary The problem of mental illness diagnoses in adolescents is that there is little variation between understanding when social problems are at the core of emotional difficulties or when the individual is experiencing the beginning of a clinical diagnosed illness that has long term consequences. Over treating with medication can lead to a belief that there is something wrong when the real problems can be treated through talk therapies that provide skills that can lead to more productive life. Defining how and when treatment is used for patients is important through proper diagnosis of problems that contribute to feelings of lowered mental well-being rather than true diagnoses of illness. Problem Statement Treatment for mental health issues for adolescents is largely confused between what should be considered social problems in comparison to what should be considered mental illness. In diagnosis, treatment, and available services, adolescents are vulnerable to inappropriate treatments where social issues have been interpreted as mental illness. Treatment that is given through primary physicians who are not focusing on social issues often leaves adolescents without coping mechanisms for social problems, while leaving those with mental illness medicated without appropriate care or services to deal with true mental illness. The following study will examine the difference between social problems and mental illness as it relates to diagnosis, treatment, and services. Methodology Overview This study will examine the problem of defining social issues from mental illness issues in adolescents in regard to diagnosis, treatment, and services through a mixed methodology study. The design of the study is intended to create relationships between variables in order to determine how diagnosis and treatment of adolescents. The study will be conducted through taking a survey of 100 adolescents who are currently undergoing treatment for mental health issues. In addition to the quantitative results of the survey, a qualitative study through interviews with twelve participants who fit specified criteria will add experiential depth to the results of the survey. Research Questions and Hypotheses Research Questions The following research questions will frame the study in order to create focus and to provide for a framework for the inquiry: 1. Is an evaluation of mental health being taken into consideration when adolescents undergo their annual visit to their primary physician? 2. If mental health issues are discovered by a family physician, how is treatment being addressed for the patient? Who is giving care? 3. When diagnosed with a mental issue, what services are available for meeting the needs for care and treatment? Hypotheses Hypothesis 1: Because mental health issues are usually brought to primary physicians, diagnosis is broad and without distinctions between true illness and social problems. Hypothesis 2: Because mental health issues are largely addressed through pharmacological solutions from primary physicians, adolescents are often not treated appropriately exacerbating problems rather than treating defined illnesses. Hypothesis 3: Because adolescent behaviour is largely anti-social, discrimination within services fails to define social issues from mental health issues. Variable operationalization Variables Variables in an experiment provide for factors that can be measured against one another in order to obtain results that can help to answer the questions that are being posed by the researcher. The variables in this research will be three age ranges which are defined as 12 to 14, 15 to 17, and 18 to 20. Demographic variable such as race, socio-economic level, and gender will also be used to create statistical references. In-patient care and out-patient care will be variables as well as diagnosis by a primary physician without care under a psychiatrist, pharmacological support and who has provided this type of care, and the perceived success rate at which the mental health issues have been treated. In addition to these variables, qualitative study of the problem will provide context as to whether or not the issues that are being treated are based on social issues or mental illness. Operationalization The operationalization of the research project will be through two methods of analysing the variables. The first will be in analysing the data from questionnaires and developing frequencies through putting the results of the survey through SPSS software. This software provides quantitative analysis of surveys that provide numerical results. The second form of data analysis will be done through codifying the common concepts that occur within the interviews and placing them in a grid that will reveal information that is consistent for the experience of adolescents as they are diagnosed, treated, and seek services for mental health issues as well as if there is differentiation between social problems and mental illness. Putting the statistical analysis in context with the commonalities that are revealed through the qualitative research will provide results towards answering the research questions. In addition, if found appropriate, case studies will provide experiential information that will further shed light on the overall analysis of the study. Sampling Sampling will be done through finding gatekeepers to organizations that service adolescents for mental illness issues. Creswell (2007) discusses the position of gatekeepers as they are the link between the type of population selection that the researcher needs and access to those who fulfil the required criteria. In order to protect the adolescents, it is their parents who will be interviewed and surveyed in order to assess the nature of diagnosis and treatment that is available to their children. Purposeful sampling strategies will be used to select the sample. Purposeful sampling provides that “the inquirer selects individuals and sites for study because they can purposefully inform an understanding of the research problem and central phenomenon within the study” (Creswell, 2007, p. 125). The criteria for participation in the study will be parents whose children have been diagnosed, treated, and in need of services for contributing to the treatment of their condition. Gatekeepers will include administrators of service facilities, doctors, and nursing staff as they are available. Research Study Design This research study will be a mixed methodology study that includes both quantitative data from survey instruments and qualitative data from semi-structured interviews. The purpose in using both methods is that a survey will inform the study as to what is occurring and the qualitative study will give greater meaning to the survey data as to the experience of what is occurring. The first part of the study will be to disseminate survey instruments to a minimum of 100 participants in order to collect data on demographics, on types of treatments, on who is doing the treatments, and if services are available to help them with their issues. Additionally, information as to whether their condition is more based on social issues or mental health issues will be addressed in the survey as well as the interviews. The first step in the study will be to send surveys to those who have agreed to participate in the study. Participation will be addressed for ethical issues through a consent form and a letter that informs the participants about the nature of the study. According to writing by Sieber (1992) “Voluntary informed consent is an on-going, two-way communication process between subjects and the investigator, as well as a specific agreement about the conditions of the research participation” (p. 26). All participants will give voluntary, informed consent. Participants will be allowed to exit the study at any point and those in the interview process will be given debriefing in order to be clear that they were ethically treated during the process and are comfortable with participation. The qualitative study will be conducted through semi-structured interviews with open ended questions that allow for the participant to describe their experiences and go off in new directions to broaden the data. The interviewer guides the direction of the discussion, but also allows for information that is not directly related to the questions (Hesse-Biber & Leavy, 2011). Data Collection and Instruments Data will be collected from a survey instrument that will be designed in order to collect information on adolescents through the information provided by their parents. In addition, semi-structured interviews of select participants will be used to develop a sense of the experiences of adolescents as they navigate their mental illness issues. Data Analysis Plan Data from the survey will be placed into a spread sheet from which means will be used to find frequencies between the data sets. In order to calculate the frequencies between variables, SPSS software will be used to establish relationships. The qualitative data will use themes that emerge in order to create concepts that are common and then codified and placed into a grid in order to assess patterns on the results of the interviews. The two sets of data that has been analysed will then be put into context with each other so that themes and results can be assessed. Data Dissemination Plan Once the data has been collected and the research questions answered, the information from the study will be disseminated to mental health professionals, primary care physicians, and into the public in order to inform on the topic. The information will be intended to enlightened stakeholders from all avenues of interest. The research will be placed into an article format in order to provide for ease of access and readability. Limitations and Policy and Practice Implications Limitations The study will be limited by the following issues: The difference between social issues and mental health issues can be subjective and may not be possible to fully define. The time that will be allowed for the study may limit the number of participants that can be used, limiting the representation of the population The experience of adolescents will be revealed through the perspective of their parents, which will mean that the information is second hand and may not represent the beliefs or experiences of the adolescent that is the subject of the discussion. The information that is presented might not represent the reality of the situation as defining factors will be filtered through perceptions of their experiences. Policy The information that is gathered may affect policy if it can effectively create a definition between social issues that are causing mental health issues and mental illness that needs to be treated through more aggressive measures. Aggressive measures can be identified as psychiatric care for illness that will likely be a lifelong condition. If this distinction can more closely be identified, then the problems with diagnosis and medications that could lead to a dependence on pharmacological solutions when coping skills are needed might be more readily addressed. Practice As the practice of psychiatric medicine is explored for how adolescent illnesses are addressed, in finding meaning between normal anti-social issues and mental illness might protect both the future of the patients and the future of those who need more extensive care. The meaning that this research may have for practice is in identifying distinctions that are currently seeing blurred lines in the treatment of adolescents. References Abela, J. R. Z., & Hankin, B. L. (2008). Handbook of depression in children and adolescents. New York: Guilford Press. Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches. Los Angeles: Sage. Creswell, J. W. (2007). Qualitative inquiry & research design: Choosing among five approaches. Thousand Oaks, Calif.: Sage. Elder, R., Evans, K., & Nizette, D. (2009). Psychiatric and mental health nursing. Sydney [etc.: Mosby. Freeth, R. (2007). Humanising psychiatry and mental health care: The challenge of the person- centred approach. Oxford: Radcliffe. Haycock, D. A., & Shaya, E. K. (2009). The everything health guide to schizophrenia: The latest information on treatment, medication, and coping strategies. Avon, Mass: Adams Media. Hesse-Biber, S. N., & Leavy, P. (2011). The practice of qualitative research. Los Angeles: SAGE. Loseke, D. R. (2003). Thinking about social problems: An introduction to constructionist perspectives. New York: Aldine de Gruyter. Miller, D. E. (2005). Attitude adjustment needed now!!!: A workbook for children with anger problems. New York: Xulon Pr. Millstein, S. G., Petersen, A. C., & Nightingale, E. O. (1993). Promoting the health of adolescents: New directions for the twenty-first century. New York: Oxford University Press. Remschmidt, H. (2007). The mental health of children and adolescents: An area of global neglect. Chichester: John Wiley & Sons. Sieber, J. E. (1992). Planning ethically responsible research: A guide for students and internal review boards. Newbury Park: Sage. Springer, D. W., Rubin, A., & Beevers, C. G. (2011). Treatment of depression in adolescents and adults. Hoboken, N.J: Wiley. Strauman, T. J., Costanzo, P. R., & Garber, J. (2011). Depression in adolescent girls: Science and prevention. New York: Guilford Press. Weis, R. (2008). Introduction to abnormal child and adolescent psychology. Los Angeles: Sage Publications. Read More