Extraordinary advances have been made in the treatment of mental illness. An understanding of what causes some mental health disorders has led to greater sophistication in tailoring treatment to the underlying basis of each disorder. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders.
Most treatment methods for mental health disorders can be categorized as either somatic or psychotherapeutic. Somatic treatments include drug therapy and electroconvulsive therapy. Psychotherapeutic treatments include individual, group, or family and marital psychotherapy; behavior therapy techniques (such as relaxation training or exposure therapy); and hypnotherapy. Most studies suggest that for major mental health disorders, a treatment approach involving both drugs and psychotherapy is more effective than either treatment method used alone.
Psychiatrists are not the only mental health care professionals trained to treat mental illness. Others include clinical psychologists, social workers, nurses, and some pastoral counselors. However, psychiatrists are the only mental health care professionals licensed to prescribe drugs. Other mental health care professionals primarily practice psychotherapy.
Types of Mental Health Care Professionals
Professional Training and Expertise
Psychiatrist
Medical doctor with 4 years of psychiatric training after graduation from medical school.
Can prescribe drugs and admit people to the hospital. Some practice psychotherapy, some only prescribe drugs, and many do both.
Psychologist Professional who has a doctorate but not a medical degree. Many have postdoctoral training, and most are trained to administer psychologic tests that are helpful in diagnosis. May conduct psychotherapy but cannot perform physical examinations, prescribe drugs, or admit people to the hospital.
Psychiatric social worker A professional with specialized training in certain aspects of psychotherapy, such as family/marital therapy or individual psychotherapy. Often trained to interface with the social service systems in the state. May have a master's degree, but some have doctorates as well. Cannot perform physical examinations or prescribe drugs.
Psychiatric nurse Registered nurse who may practice psychotherapy independently in some states and may prescribe drugs under the supervision of a doctor.
Psychoanalyst May be a psychiatrist, psychologist, or social worker who has many years of training in the practice of psychoanalysis, a type of intensive psychotherapy involving several sessions a week designed to explore unconscious patterns of thought, feeling, and behavior. Psychoanalysts who are also psychiatrists may prescribe drugs and admit people to hospitals in addition to conducting psychoanalysis.
Drug Therapy
Over the last 40 years, a number of psychoactive drugs have been developed that are highly effective and widely used by psychiatrists and other medical doctors. These drugs are often categorized according to the disorder for which they are primarily prescribed. For example, antidepressants are used to treat depression. Selective serotonin reuptake inhibitors are the newest and most widely used class of antidepressants. Other new classes of antidepressants are being developed.
Electroconvulsive Therapy
With electroconvulsive therapy, electrodes are attached to the head, and a series of electrical shocks are delivered to the brain to induce seizures. This therapy has consistently been shown to be the most effective treatment for severe depression. Many people treated with electroconvulsive therapy experience temporary memory loss. However, contrary to its portrayal in the media, electroconvulsive therapy is safe and rarely causes any other complications. The modern use of anesthetics and muscle relaxants has greatly reduced any risk to the person.
Psychotherapeutic Treatments
In recent years, significant advances have been made in the field of psychotherapeutic treatments. Psychotherapy, sometimes referred to as "talk" therapy, works on the assumption that each person has within himself the cure for his own suffering and that this cure can be facilitated through a trusting, supportive relationship with a psychotherapist. By creating an empathetic and accepting atmosphere, the therapist often is able to help the person identify the source of his problems and consider alternatives for dealing with them.
The emotional awareness and insight that the person gains through psychotherapy often results in a change in attitude and behavior that allows the person to live a fuller and more satisfying life. Psychotherapy is appropriate in a wide range of conditions. Even people who do not have a mental health disorder may find psychotherapy helpful in coping with such problems as employment difficulties, bereavement, or chronic illness in the family. Group psychotherapy, couples' therapy, and family therapy are also widely used.
Most mental health professionals practice within one of five types of psychotherapy: psychoanalysis, psychodynamic psychotherapy, cognitive therapy, behavior therapy, or interpersonal therapy. Psychoanalysis is the oldest form of psychotherapy and was developed by Sigmund Freud in the first part of the 20th century. The person typically lies on a couch in the therapist's office 4 or 5 times a week and attempts to say whatever comes into his mind, a practice called free association.
Much of the focus is on understanding how past patterns of relationships repeat themselves in the present. The relationship between the person and the therapist is a key part of this focus. An understanding of how the past affects the present helps the person develop new and more adaptive ways of functioning in relationships and in work settings.
Psychodynamic psychotherapy, like psychoanalysis, emphasizes the identification of unconscious patterns in current thoughts, feelings, and behaviors. However, the person is usually sitting instead of lying on a couch and attends only 1 to 3 sessions per week. In addition, less emphasis is placed on the relationship between the person and therapist.
Cognitive therapy helps people identify distortions in thinking and understand how these distortions lead to problems in their lives. The underlying premise is that how people feel and behave are determined by how they interpret experiences. Through the identification of core beliefs and assumptions, people can begin to think in different ways about their experiences, resulting in improvement in symptoms, behavior, and feelings.
Behavior therapy is related to cognitive therapy. Sometimes, a
combination of the two, known as cognitive-behavior therapy, is used. The theoretical basis of behavior therapy is learning theory, which holds that abnormal behaviors are due to faulty learning. Behavior therapy involves a number of interventions that are designed to help the person unlearn maladaptive behaviors while learning adaptive behaviors. Exposure therapy is one example of a behavior therapy (see
What Is Exposure Therapy? ).
Interpersonal therapy was initially conceived as a brief psychologic treatment for depression and is designed to improve the quality of a depressed person's relationships. It focuses on unresolved grief, conflicts that arise when people fill roles that differ from their expectations (such as when a woman enters a relationship expecting to be a stay-at-home mother and finds that she must also be the major provider for the family), social role transitions (such as going from being an active worker to being retired), and difficulty communicating with others. The therapist teaches the person to improve aspects of interpersonal relationships, such as overcoming social isolation and responding in a less habitual way to others.
Hypnosis and Hypnotherapy
Hypnosis and hypnotherapy are often used to manage pain and treat physical disorders that have a psychologic component. Hypnosis is simply the induction of a trance or altered state of consciousness, whereas hypnotherapy involves psychotherapeutic intervention in conjunction with the hypnotic state. These techniques may promote relaxation and thereby lower anxiety and reduce tension. For example, hypnosis and hypnotherapy can help people with cancer who have anxiety or depression in addition to pain.
About 20% of American children suffer from a diagnosable mental illness during a given year, according to the U.S. Surgeon General. Further, nearly 5 million American children and adolescents suffer from a serious mental illness (one that significantly interferes with their day-to-day life).
Which Mental Illnesses Are Most Common in Children?
Children can suffer from the following mental illnesses:
• Anxiety disorders: Children with anxiety disorders respond to certain things or situations with fear and dread, as well as with physical signs of anxiety (nervousness), such as a rapid heartbeat and sweating.
• Disruptive behavior disorders: Children with these disorders tend to defy rules and often are disruptive in structured environments, such as school.
• Pervasive development disorders: Children with these disorders are confused in their thinking and generally have problems understanding the world around them.
• Eating disorders: Eating disorders involve intense emotions and attitudes, as well as unusual behaviors, associated with weight and/or food.
• Elimination disorders: These disorders affect behavior related to the elimination of body wastes (feces and urine).
• Learning and communication disorders: Children with these disorders have problems storing and processing information, as well as relating their thoughts and ideas.
• Affective (mood) disorders: These disorders involve persistent feelings of sadness and/or rapidly changing moods.
• Schizophrenia: This is a serious disorder that involves distorted perceptions and thoughts.
• Tic disorders: These disorders cause a person to perform repeated, sudden, involuntary and often meaningless movements and sounds, called tics.
Some of these illnesses, such as anxiety disorders, eating disorders, mood disorders and schizophrenia, can occur in adults as well as children. Others, such as behavior and development disorders, elimination disorders, and learning and communication disorders, begin in childhood only, although they can continue into adulthood. In rare cases, tic disorders can develop in adults. It is not unusual for a child to have more than one disorder.
What Are the Symptoms of Mental Illness in Children?
Symptoms vary depending on the type of mental illness, but some of the general symptoms include:
• Abuse of drugs and/or alcohol
• Inability to cope with daily problems and activities
• Changes in sleeping and/or eating habits
• Excessive complaints of physical ailments
• Defying authority, skipping school, stealing or damaging property
• Intense fear of gaining weight
• Long-lasting negative moods, often accompanied by poor appetite and thoughts of death
• Frequent outbursts of anger
• Changes in school performance, such as poor grades despite good efforts
• Loss of interest in friends and activities they usually enjoy
• Significant increase in time spent alone
• Excessive worrying or anxiety
• Hyperactivity
• Persistent nightmares
• Persistent disobedience or aggressive behavior
• Frequent temper tantrums
• Hearing voices or seeing things that are not there (hallucinations)
What Causes Mental Illness?
The exact cause of most mental disorders is not known, but research suggests that a combination of factors, including heredity, biology, psychological trauma and environmental stress, may be involved.
• Heredity (genetics): Mental illness tends to run in families, which means the likelihood to develop a mental disorder may be passed on from parents to their children.
• Biology: Some mental disorders have been linked to special chemicals in the brain called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages may not make it through the brain correctly, leading to symptoms. In addition, defects in or injury to certain areas of the brain also have been linked to some mental illnesses.
• Psychological trauma: Some mental illnesses may be triggered by psychological trauma, such as severe emotional, physical or sexual abuse; an important early loss, such as the loss of a parent; and neglect.
• Environmental stress: Stressful or traumatic events can trigger a mental illness in a person with a vulnerability to a mental disorder.
How Is Mental Illness in Children Diagnosed?
As with adults, mental illnesses in children are diagnosed based on signs and symptoms that suggest a particular disorder. However, this process can be especially challenging with children. Many behaviors that are seen as symptoms of mental disorders, such as shyness, anxiety (nervousness), strange eating habits and outbursts of temper, can occur as a normal part of a child's development. Behaviors become symptoms when they occur very often, last a long time, occur at an unusual age or cause significant disruption to the child's and/or family's ability to function.
If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose mental disorders, the doctor may use various tests, such as X-rays and blood tests, to rule out physical illness or medication side effects as the cause of the symptoms.
If no physical illness is found, the child may be referred to a child and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illness in children and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental disorder. The doctor bases his or her diagnosis on reports of the child's symptoms and his or her observation of the child's attitude and behavior. The doctor often must rely on reports from the child's parents, teachers and other adults because children often have trouble explaining their problems or understanding their symptoms.
How Is Mental Illness in Children Treated?
Mental disorders are like many medical illnesses that require ongoing treatment. Although much progress has been made in the treatment of adults with mental disorders, the treatment of children is not as well understood. Experts are still exploring which treatments work best for which conditions in children. For now, many of the treatment options used for children, including many medications, are the same as what is used to treat adults. The most common treatment options used include:
• Medication: Many mental illnesses can be effectively treated with medications. The medications often used to treat mental disorders in children include antipsychotics, antidepressants and antianxiety drugs, stimulants and mood stabilizing drugs.
• Psychotherapy: Psychotherapy (a type of counseling) addresses the emotional response to mental illness. It is a process in which trained mental health professionals help people deal with their illness, often by talking through strategies for understanding and dealing with their symptoms, thoughts and behaviors. Types of psychotherapy often used with children are supportive, cognitive-behavioral, interpersonal, group and family therapy.
• Creative therapies: Certain therapies, such as art therapy or play therapy, may be helpful, especially with young children who may have trouble communicating their thoughts and feelings.
What Is the Outlook for Children With Mental Illness?
When treated appropriately and early, many children can fully recover from their mental illness or successfully control their symptoms. While some children become disabled adults because of a chronic or severe disorder, many people who have a mental illness are able to live full and productive lives.
It is very important to seek treatment for your child if they are displaying any symptoms of mental illness. Without treatment, many mental disorders can continue into adulthood and lead to problems in all areas of the person's adult life. People with untreated mental disorders are at high risk for many problems, including alcohol or drug abuse, and violent or self-destructive behavior, even suicide.
What Research Is Being Done on Mental Illness in Children?
To date, most research on mental illness has centered on mental disorders in adults. However, the mental health community has now begun to focus on mental illness in children. Researchers are looking at childhood development in terms of what is normal and abnormal, trying to understand how factors affecting development can have an impact on mental health. The goal is to try to predict, and ultimately, prevent, developmental problems that could lead to mental illness. A key part of this research is the identification of risk factors -- factors that increase a child's chances of developing a mental disorder. In addition, the mental health community is calling for additional research on medications used to treat children with mental disorders.
Can Mental Illness in Children Be Prevented?
Most mental disorders are caused by a combination of factors and cannot be prevented. However, if symptoms are recognized and treatment is started early, many of the distressing and disabling effects of a mental illness may be prevented or at least minimized.
Mental Health:
Mental Illness Basics
Mental illness is any disease or condition affecting the brain that influence the way a person thinks, feels, behaves and/or relates to others and to his or her surroundings. Although the symptoms of mental illness can vary from mild to severe and are different depending on the type of mental illness, a person with an untreated mental illness often is unable to cope with life's daily routines and demands.
What Causes Mental Illness?
Although the exact cause of most mental illnesses is not known, it is becoming clear through research that many of these conditions are caused by a combination of genetic, biological, psychological and environmental factors. One thing is for sure -- mental illness is not the result of personal weakness, a character defect or poor upbringing, and recovery from a mental illness is not simply a matter of will and self-discipline.
• Heredity (genetics): Many mental illnesses run in families, suggesting that the illnesses may be passed on from parents to children through genes. Genes contain instructions for the function of each cell in the body and are responsible for how we look, act, think, etc. But, just because your mother or father may have a mental illness doesn't mean you will have one. Hereditary just means that you are more likely to get the condition than if you didn't have an affected family member. Experts believe that many mental conditions are linked to problems in multiple genes -- not just one, as with many diseases -- which is why a person inherits a susceptibility to a mental disorder, but doesn't always develop the condition. The disorder itself occurs from the interaction of these genes and other factors -- such as psychological trauma and environmental stressors -- which can influence, or trigger, the illness in a person who has inherited a susceptibility to it.
• Biology: Some mental illnesses have been linked to an abnormal balance of special chemicals in the brain called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or are not working properly, messages may not make it through the brain correctly, leading to symptoms of mental illness. In addition, defects in or injury to certain areas of the brain also have been linked to some mental conditions.
• Psychological trauma: Some mental illnesses may be triggered by psychological trauma suffered as a child, such as severe emotional, physical or sexual abuse; a significant early loss, such as the loss of a parent; and neglect.
• Environmental stressors: Certain stressors -- such as a death or divorce, a dysfunctional family life, changing jobs or schools and substance abuse -- can trigger a disorder in a person who may be at risk for developing a mental illness.
Can Mental Illness Be Prevented?
Unfortunately, most mental illnesses are caused by a combination of factors and cannot be prevented.
How Common Is Mental Illness?
Mental illnesses are very common. In fact, they are more common than cancer, diabetes or heart disease. According to the U.S. Surgeon General, an estimated 23% of American adults (those ages 18 and older) -- about 44 million people -- and about 20% of American children suffer from a mental disorder during a given year. Further, about 5 million Americans adults, and more than 5 million children and adolescents suffer from a serious mental condition (one that significantly interferes with functioning).
Mental Health:
Mental Illness in Children
About 20% of American children suffer from a diagnosable mental illness during a given year, according to the U.S. Surgeon General. Further, nearly 5 million American children and adolescents suffer from a serious mental illness (one that significantly interferes with their day-to-day life).
Which Mental Illnesses Are Most Common in Children?
Children can suffer from the following mental illnesses:
• Anxiety disorders: Children with anxiety disorders respond to certain things or situations with fear and dread, as well as with physical signs of anxiety (nervousness), such as a rapid heartbeat and sweating.
• Disruptive behavior disorders: Children with these disorders tend to defy rules and often are disruptive in structured environments, such as school.
• Pervasive development disorders: Children with these disorders are confused in their thinking and generally have problems understanding the world around them.
• Eating disorders: Eating disorders involve intense emotions and attitudes, as well as unusual behaviors, associated with weight and/or food.
• Elimination disorders: These disorders affect behavior related to the elimination of body wastes (feces and urine).
• Learning and communication disorders: Children with these disorders have problems storing and processing information, as well as relating their thoughts and ideas.
• Affective (mood) disorders: These disorders involve persistent feelings of sadness and/or rapidly changing moods.
• Schizophrenia: This is a serious disorder that involves distorted perceptions and thoughts.
• Tic disorders: These disorders cause a person to perform repeated, sudden, involuntary and often meaningless movements and sounds, called tics.
Some of these illnesses, such as anxiety disorders, eating disorders, mood disorders and schizophrenia, can occur in adults as well as children. Others, such as behavior and development disorders, elimination disorders, and learning and communication disorders, begin in childhood only, although they can continue into adulthood. In rare cases, tic disorders can develop in adults. It is not unusual for a child to have more than one disorder.
What Are the Symptoms of Mental Illness in Children?
Symptoms vary depending on the type of mental illness, but some of the general symptoms include:
• Abuse of drugs and/or alcohol
• Inability to cope with daily problems and activities
• Changes in sleeping and/or eating habits
• Excessive complaints of physical ailments
• Defying authority, skipping school, stealing or damaging property
• Intense fear of gaining weight
• Long-lasting negative moods, often accompanied by poor appetite and thoughts of death
• Frequent outbursts of anger
• Changes in school performance, such as poor grades despite good efforts
• Loss of interest in friends and activities they usually enjoy
• Significant increase in time spent alone
• Excessive worrying or anxiety
• Hyperactivity
• Persistent nightmares
• Persistent disobedience or aggressive behavior
• Frequent temper tantrums
• Hearing voices or seeing things that are not there (hallucinations)
What Causes Mental Illness?
The exact cause of most mental disorders is not known, but research suggests that a combination of factors, including heredity, biology, psychological trauma and environmental stress, may be involved.
• Heredity (genetics): Mental illness tends to run in families, which means the likelihood to develop a mental disorder may be passed on from parents to their children.
• Biology: Some mental disorders have been linked to special chemicals in the brain called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages may not make it through the brain correctly, leading to symptoms. In addition, defects in or injury to certain areas of the brain also have been linked to some mental illnesses.
• Psychological trauma: Some mental illnesses may be triggered by psychological trauma, such as severe emotional, physical or sexual abuse; an important early loss, such as the loss of a parent; and neglect.
• Environmental stress: Stressful or traumatic events can trigger a mental illness in a person with a vulnerability to a mental disorder.
How Is Mental Illness in Children Diagnosed?
As with adults, mental illnesses in children are diagnosed based on signs and symptoms that suggest a particular disorder. However, this process can be especially challenging with children. Many behaviors that are seen as symptoms of mental disorders, such as shyness, anxiety (nervousness), strange eating habits and outbursts of temper, can occur as a normal part of a child's development. Behaviors become symptoms when they occur very often, last a long time, occur at an unusual age or cause significant disruption to the child's and/or family's ability to function.
If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose mental disorders, the doctor may use various tests, such as X-rays and blood tests, to rule out physical illness or medication side effects as the cause of the symptoms.
If no physical illness is found, the child may be referred to a child and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illness in children and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental disorder. The doctor bases his or her diagnosis on reports of the child's symptoms and his or her observation of the child's attitude and behavior. The doctor often must rely on reports from the child's parents, teachers and other adults because children often have trouble explaining their problems or understanding their symptoms.
How Is Mental Illness in Children Treated?
Mental disorders are like many medical illnesses that require ongoing treatment. Although much progress has been made in the treatment of adults with mental disorders, the treatment of children is not as well understood. Experts are still exploring which treatments work best for which conditions in children. For now, many of the treatment options used for children, including many medications, are the same as what is used to treat adults. The most common treatment options used include:
• Medication: Many mental illnesses can be effectively treated with medications. The medications often used to treat mental disorders in children include antipsychotics, antidepressants and antianxiety drugs, stimulants and mood stabilizing drugs.
• Psychotherapy: Psychotherapy (a type of counseling) addresses the emotional response to mental illness. It is a process in which trained mental health professionals help people deal with their illness, often by talking through strategies for understanding and dealing with their symptoms, thoughts and behaviors. Types of psychotherapy often used with children are supportive, cognitive-behavioral, interpersonal, group and family therapy.
• Creative therapies: Certain therapies, such as art therapy or play therapy, may be helpful, especially with young children who may have trouble communicating their thoughts and feelings.
What Is the Outlook for Children With Mental Illness?
When treated appropriately and early, many children can fully recover from their mental illness or successfully control their symptoms. While some children become disabled adults because of a chronic or severe disorder, many people who have a mental illness are able to live full and productive lives.
It is very important to seek treatment for your child if they are displaying any symptoms of mental illness. Without treatment, many mental disorders can continue into adulthood and lead to problems in all areas of the person's adult life. People with untreated mental disorders are at high risk for many problems, including alcohol or drug abuse, and violent or self-destructive behavior, even suicide.
What Research Is Being Done on Mental Illness in Children?
To date, most research on mental illness has centered on mental disorders in adults. However, the mental health community has now begun to focus on mental illness in children. Researchers are looking at childhood development in terms of what is normal and abnormal, trying to understand how factors affecting development can have an impact on mental health. The goal is to try to predict, and ultimately, prevent, developmental problems that could lead to mental illness. A key part of this research is the identification of risk factors -- factors that increase a child's chances of developing a mental disorder. In addition, the mental health community is calling for additional research on medications used to treat children with mental disorders.
Can Mental Illness in Children Be Prevented?
Most mental disorders are caused by a combination of factors and cannot be prevented. However, if symptoms are recognized and treatment is started early, many of the distressing and disabling effects of a mental illness may be prevented or at least minimized.
