Mental Health Care In A High School Based Health Service

Adolescence, Spring, 1998 by Lisa Jepson, Linda Juszczak, Martin Fisher

Because youth suicide is now recognized as a national mental health problem (Alcohol, Drug Abuse, and Mental Health Administration, 1989), all students who screen positively for a history of suicidal ideation are referred for a more in-depth interview with one of the clinic's mental health providers. It has been our experience that large numbers of teens at risk for suicide seek clinic services. In the group for children of substance abusers alone, four of the nine members admitted past suicidal ideation, with one having made a suicidal gesture. Although some of the reports of previous suicidal ideation represent issues that have already been resolved by the student, our screening and referral practice has nonetheless been invaluable. In addition to identifying students experiencing active suicidal ideation, this process immediately establishes the potential for a caring relationship upon which each student at risk for suicide can rely throughout the remainder of his or her high school experience. Speaking w ith a mental health professional can reassure adolescents that the developmental changes they are experiencing can be contextualized and understood. This can be particularly helpful for youth who, in addition to experiencing the challenge of adolescence, are confronted with parent conflict or acculturation issues, because each of these factors may have an impact on their senses of identity, agency, and security.

An interesting finding was the high percentage (34%) of teens reporting problematic substance use among family members. During the first years of clinic operation, staff were surprised by the low incidence of substance abuse among students. When the problem was redefined to include family members, striking results began to emerge, suggesting a possible link between high-risk behaviors among both youth and family members. The psychosocial stressors among members of the group for children of substance abusers provide some indication of the plausibility of such a link. One of the group members reported that her pregnancy represented an attempt to gain the unconditional love she never felt she received from either of her substance-dependent parents. She worried, however, that becoming pregnant at 16 reenacted what her mother had done at the same age, which made her question her ability to care for her unborn child.

Other links between family substance abuse and high-risk behaviors among youth emerged from group discussions about conflict management and coping skills. When confronted with conflict, violence, or sexually inappropriate behavior on the part of substance-dependent caretakers, many group members reported engaging in physical violence, running away, or making plans to live with others. Given their sense of insecurity, desperation, and low self-esteem, it is not surprising that many of the alternatives these young women sought ultimately perpetuated their experiences of self-defeat. Due perhaps to underlying identification with substance-dependent parents, or to an intense longing for relationships with emotionally unavailable parents, several group members admitted their own increasing use of alcohol and marijuana. For those youth, who often feel responsible for family troubles, the developmental task of emotional separation and differentiation from family members and caretakers is particularly difficult. It is not unusual, for example, for students who have had enormous social and academic success to suddenly begin having difficulties during their senior year while applying to college or making plans to move away from a chaotic home environment.