Teen Newsletter: November 2020 – Mental Health

Public health problems are diverse and can include infectious diseases, chronic diseases, emergencies, injuries, environmental health problems, as well as other health threats. Regardless of the topic, we take the same systematic, science-based approach to a public health problem by following four general steps. CDC works to prevent or reduce the impact of mental illness in the following ways:

1. Surveillance (What is the problem?)

In public health, we identify the problem by using surveillance systems to monitor health events and behaviors occurring among a population.

Mental illnesses are among the most common health conditions in the U.S.

• More than 50% will be diagnosed with a mental illness or disorder at some point in their lifetime.
• 

  1 in 5 Americans will experience a mental illness in a given year.

• 1 in 5 children, either currently or at some point during their life, have had a seriously debilitating mental illness.
• Half of all chronic mental illness begins by age 14 and three-quarters begin by age 24.
• 1 in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression.

CDC uses existing national public health surveys to assess the prevalence, severity, and economic impact of mental disorders in the U.S. and monitor trends and patterns over time.

• Behavioral Risk Factor Surveillance System (BRFSS) Questions include recent mentally unhealthy days, anxiety and depressive disorders, mental illness and stigma, and psychological distress.
• National Health and Nutrition Examination Survey (NHANES) Collects data covering a number of conditions, including depression and anxiety, symptoms of conditions, concerns associated with mental health and substance abuse, and mental health service use and need.
• National Health Interview Survey (NHIS) Questions include serious psychological distress, feelings of depression and anxiety, presence of attention deficit/hyperactivity disorder and autism spectrum disorder. The NHIS also examines mental health service use and whether individuals have unmet mental health needs.
• National Ambulatory Medical Care Survey Collects data on type of provider, medications, primary diagnoses and presence of long-lasting conditions.
• National Hospital Care Survey (NHCS) Examines care provided across treatment settings.
• National Study of Long-Term Care Providers (NSLTCP) Monitors mental illness, depression, and service use.
• National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (NS-DATA) Collects information about children 2 to 15 years old who had ever been diagnosed with attention-deficit/hyperactivity disorder (ADHD) and/or Tourette syndrome (TS) with the goal of better understanding diagnostic practices, level of impairment, and treatments for this group of children.
• National Violent Death Reporting System (NVDRS) Collects data from medical examiners, coroners, police, crime labs, and death certificates to understand the circumstances surrounding violent deaths, including suicide. NVDRS can also provide details on the circumstances that may have led to violent deaths, including mental illness and mental disorders.
• Pregnancy Risk Assessment Monitoring System (PRAMS) Collects data on maternal attitudes and experiences before, during, and after pregnancy; includes the prevalence of self-reported postpartum depression and anxiety symptoms.
• School Health Policies and Programs Study (SHPPS) Collects data on mental health and social service policies.
• WISQARS™ CDC’s WISQARS™ (Web-based Injury Statistics Query and Reporting System) is an interactive database system that provides customized reports of injury-related data, such as intentional self-harm including suicide.
• National Survey of Children’s Health (NSCH) Examines the health of children including those with special needs with an emphasis on well-being, collects information on the presence of a mental or behavioral problem.
• Youth Risk Behavior Surveillance System (YRBSS) The YRBSS monitors health-risk behaviors including injuries and violence.

2. Risk Factor Identification (What is the cause?)

After we’ve identified the problem, the next question is, “What is the cause of the problem?” For example, are there factors that might make certain populations more susceptible, such as something in the environment or certain behaviors that people are practicing?

There is no single cause for mental illness. A number of factors can contribute to risk for mental illness, such as

• • Early adverse life experiences, such as trauma or a history of abuse (for example, child abuse, sexual assault, witnessing violence)
  • Experiences related to other ongoing (chronic) medical conditions, such as cancer or diabetes.
  • Biological factors, such as genes or chemical imbalances in the brain
  • Use of alcohol or recreational drugs
  • Having few friends
  • Having feelings of loneliness or isolation

3. Intervention Evaluation (What works?)

Once we’ve identified the risk factors related to the problem, we ask, “What intervention works to address the problem?” We look at what has worked in the past in addressing this same problem and if a proposed intervention makes sense with our affected population.

Tools – CDC translates research into evidence-based interventions that can be used by health care providers and communities to prevent adverse outcomes associated with mental illness.

Resources – CDC shares effective interventions and implements a coordinated approach among all groups that provide mental health services.

One group that is well known for leading public health efforts to advance the behavioral health of the nation is CDC’s sister agency, the Substance Abuse and Mental Health Services Administration (SAMHSA).

SAMHSA is within the U.S. Department of Health and Human Services, just like CDC. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities.

It provides one-stop access to U.S. government information on mental health and mental health problems. It aims to educate and guide:

• 

  The general public

• Health and emergency preparedness professionals
• Policy makers
• Government and business leaders
• School systems
• Local communities

Content for SAMHSA is provided by:

• Centers for Disease Control and Prevention
• MedlinePlus
• National Institutes of Health
• National Institute of Mental Health
• Substance Abuse and Mental Health Services Administration
• Youth.gov

4. Implementation (How can we do it?)

In the last step, we ask, “How can we implement the intervention? Given the resources we have and what we know about the affected population, will this work?”

CDC monitors and evaluates services and treatments of mental disorders to identify, improve, and scale what works.

As you can see, using The Public Health Approach helps public health professionals identify a problem, find out what is causing it, and determine what solutions/interventions work.

Mental health is important for everyone, including professionals working a public health emergency response. Learn how CDC helped responders cope with stress and build resilience during a past epidemic.

On March 23, 2014, the WHO reported cases of Ebola Virus Disease (EVD) in the forested rural region of southeastern Guinea. The identification of these cases marked the beginning of the West Africa Ebola epidemic, the largest in history.

Take a look at the history of Ebola in West Africa (2014-2016) through the digital exhibition EBOLA: People + Public Health + Political Will. Learn how CDC, global partners, governments, organizations, and individuals came together to stop an epidemic.

Hear from Commander Jennifer Bornemann, LCSW describe her work as a behavioral health/resilience officer in the Monrovia Medical Unit (MMU). The MMU was an Ebola treatment unit in Liberia staffed by United States Public Health Service commissioned officers that treated healthcare workers during the 2014 Ebola epidemic (Fast Fact— they were the only U.S. federal entity to directly treat anyone with Ebola). “We were seen as a sense of hope, which was quite a privilege” – CDR Bornemann.

Does the name Commander Jennifer Bornemann sound familiar? It should, she was a guest speaker on our July 2020 Newsletter Zoom.

Below you can see the U.S. Flag made with Handprints of Hope.

Commander Jennifer Bornemann received this flag while at the MMU. It was made by kindergarten students from Mrs. Julie O’Malley’s kindergarten class at St. Mary’s Elementary School in Annapolis, MD. The flag was sent to encourage the officers and boost morale. It hung with great pride at the MMU and it was displayed for all visitors to see. “It was a reminder of home that we saw daily,” said one of the United States Public Health Service commissioned officers stationed at the MMU. The MMU has since been decommissioned, the flag has been returned to the U.S. and it is now part of the CDC Museum collection.

As you know, CDC is also responding to the COVID-19 pandemic. Part of the response is helping healthcare personnel and first responders cope with stress and build resilience during the pandemic.