How Trained Service Professionals and Self-Advocacy Makes a Difference for Youth with Mental Health, Substance Abuse, or Co-occurring Issues


History of Mental Health Problems. Young people with a history of mental health problems can present significant challenges for professionals working with transition-aged youth as the service providers try to understand and adequately address a young person’s needs. Conversely, traditional mental health service systems can present challenges for youth as they try to navigate the system and access services. The result can be a system that falls short of effectively addressing the needs of youth and youth who fall short of receiving the services and supports they need.

Co-occurring Mental Health and Substance Abuse Problems. Youth with co-occurring disorders often do not seek treatment and find substances to self-medicate their depression, anxiety, and erratic thoughts. About 22.1 percent of youth between the ages of 12 and 17 who experienced a major depressive episode also met the criteria for substance abuse or dependence for illicit drugs and/or alcohol within the same time period.1 Youth aged 12 to 17 with past-year major depressive episodes were more likely than those without past-year major depressive episodes to be dependent on illicit drugs within the past year (14.3 vs. 3.8 percent), dependent on alcohol within the past year (12.3 vs. 3.8 percent), to report using cigarettes daily within the past month (3.1 vs.1.8 percent), or dependent on both illicit drugs and alcohol within the past year (19.9 vs. 6.1 percent).2

Youth with co-occurring disorders present additional challenges for professionals in the area of service provision. It should be noted that many mental health professionals are not trained in treatment of co-occurring disorders, and this is true for substance abuse treatment professionals as well. Often youth are referred to two separate agencies for services. Because the mental health/substance abuse problems are intertwined, effective treatment for one cannot be successful without consideration of the other. Without the correct diagnosis, monitoring, and treatment (and medication, if needed), youth often become frustrated with unsuccessful treatment and stop participating in services. A young person is more likely to continue treatment once a therapeutic relationship with a counselor trained in co-occurring disorders is formed and the youth experiences some success in addressing his or her problems.

Young people with mental health needs often do not receive adequate screening, assessment, treatment, or transition planning services as children, as adolescents, and as they move into adulthood. The multiple systems that young people are involved with often overlook the symptoms of depression, anxiety, trauma, and other issues due to lack of understanding of the mental health needs of young people, as well as a lack of awareness of the resources available to assist them. This is particularly true for youth of color, youth in juvenile justice populations, and youth from low-income families. The 2009 National Survey on Drug Use and Health of transition age youth (18+ years) found that

  • 32.9 percent receive mental health care only;
  • 3.8 percent receive treatment for substance use problems only; and
  • 7.4 percent receive treatment for both mental health and substance abuse problems.3

The lack of prevention and treatment for mental health issues occurring in childhood and adolescence has significant and long-term repercussions as youth transition to adulthood. Young people with untreated mental health and substance abuse needs are more likely to experience school failure and have higher rates of dropout and “pushout.”4  Pushout refers to a student who leaves school before graduation through the encouragement of the school, often in response to behavioral incidents that have resulted in suspensions or expulsions. Students with mental health disorders are more likely to be suspended or expelled, and less likely to complete high school than their peers.5 Mental disorders are also associated with unemployment, underemployment, teenage pregnancy, unstable relationships, and justice system involvement.6

Transition-aged youth may encounter significant challenges as they move from the classroom into adulthoodand a lack of treatment coupled with the lack of transition planning services can set-up these youth for failure. Unfortunately, few coordinated systems exist for assisting young people with mental health needs in their transition to adulthood.7 Additionally, because many young people with mental health needs may miss significant portions of the school year, their education can be disrupted, leading to gaps in their learning.8

Young people with a history of mental health difficulties need to develop an individualized transition plan with the skilled assistance of an intensive case manager who supports and assists the young person with obtaining resources in order to transition successfully to adulthood.

1, 2 SAMHSA, 2012a
3 SAMHSA, 2009
4, 5 Bazelon, 2011
6 Epstein et al., 2004; NCCP, 2006; National Collaborative on Workforce and Disability (NCWD), 2009
7, 8 NCWD, 2009