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Young Adults Falling Into Treatment Gap

New federal initiatives aim to transition young adults with serious mental illness from treatment to productive roles in society.

The obligation that society has felt toward children with serious mental illness has resulted in widespread state and federal programs and substantial funding to treat mental illness and provide other services to minors. But after the youth turn 18, many are left on their own.

A new effort aims to provide better support to young adults with serious mental illness. In June federal legislators introduced measures (HR 7375 and S 3195) to bolster state efforts to help young people with serious mental illness better handle the transition from childhood to adulthood.

"Too many young adults with mental illness are falling through the cracks of our fragmented mental health system," said Rep. Pete Stark (D-Calif.) in a written statement. "We have an obligation to these youth to provide appropriate and effective treatment and supports so that they can make the transition to independent and successful adults."

Introduction of the legislation followed the release of a Government Accountability Office (GAO) report in June that noted that at least 2.4 million young adults aged 18 through 26—or 6.5 percent of noninstitutionalized young adults in that age range—had a serious mental illness in 2006. The GAO also found that this group had less education and a higher rate of unemployment on average than young adults without serious mental illness.

The report used the federal definition of serious mental illness: "a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within DSM-III-R, which resulted in functional impairment that substantially interferes with or limits one or more major life activities."

The actual number of young adults with serious mental illness is likely higher because the estimate did not include homeless, institutionalized, or incarcerated youth.

"Under the best of circumstances, the transition years from adolescence to adulthood are rarely easy," said Michael Fitzpatrick, executive director of the National Alliance on Mental Illness, in a statement about the report. "They are infinitely harder for young adults, ages 18 to 26, who live with illnesses such as schizophrenia and bipolar disorder."

The report also noted that among seriously mentally ill youth, nearly 90 percent had more than one mental disorder. About 186,000 young adults received Social Security Administration disability benefits in 2006 because of a mental illness that prevented them from engaging in substantial, gainful activity.

The difficulty in their transitioning to adulthood, according to the report, stems from the lack of available supports, including mental health care, employment, and housing services, which are not always suited to young adults with mental illness. This group also can find it difficult to qualify for adult programs that provide or pay for mental health services, which then results in disrupted treatment and worsening health.

The many young adults with multiple conditions are further challenged by the difficulty of "navigating multiple discrete programs that address varied needs," according to the GAO report.

Sen. Gordon Smith (R-Ore.) noted that young adulthood is especially difficult for people with mental illness who are trying to juggle increasing responsibilities while seeking mental health care.

"My son Garrett struggled with his transition to adulthood and in his ability to access the help he needed during this critical time," Smith said about his son, who committed suicide at age 21 in 2003. "These young adults deserve our attention, our support, and our compassion."

The GAO found that states provide varying levels of supports to these young adults. Among the better efforts are programs that integrate mental health treatment with employment and other services. To varying degrees, states manage to find their own and federal funding to coordinate services across multiple agencies for this population and involve young adults and their families in developing policies and aligning supports.

Past federal efforts to assist young adults with serious mental illness have included support of state demonstration projects, technical assistance, and research. Federal agencies also have established bodies to coordinate programs that serve youth with mental health needs, youth with physical disabilities, and such youth in transition to adulthood.

The limited state and federal efforts are not sufficient to truly help this population, which is large and has real, demonstrated needs, said mental health advocates.

"We need a 50-state strategy to provide life skills, education, housing, supported employment, and other services that can serve as a foundation for the future of young adults in transition who live with mental illness," Fitzpatrick said.

The recently introduced federal legislation would provide grants to states to develop statewide coordination plans to assist adolescents and young adults with serious mental illness and get access to resources they need to make a successful transition to adulthood. After the Substance Abuse and Mental Health Services Administration (SAMHSA) has approved their plan, states can compete for a second round of grants to help them implement their plan.

In addition, the legislation would fund a coordinating committee among federal agencies to ensure that programs that assist adolescents and young adults with mental illness at the federal level work together and provide technical assistance to states as they implement their coordination plans. The federal group also would be required to report to Congress on the committee's progress.

"We know that we can do a better job of helping these youth," Smith said. "We can do better at ensuring they can remain stable in their communities, that they can live healthy lives, and that they can prosper as adults."

The Healthy Transition Act of 2008 can be accessed at <http://thomas.loc.gov> by searching on the bill numbers, HR 7375 and S 3195. The GAO report, "Young Adults With Serious Mental Illness: Some States and Federal Agencies Are Taking Steps to Address Their Transition Challenges," is posted at <www.gao.gov/new.items/d08678.pdf>.

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