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 From the CEO

There is a certain type of special needs child that I've always had a professional and personal interest and concern for – that of the mentally ill child. My reference here is not limited to mental illness associated directly or indirectly with intellectual and developmental disabilities, including autism, Down syndrome and fetal alcohol syndrome. The mental illness afflicting children that I'm referring to are those suffering from mood or anxiety disorders at a young age that present risk for deep depression and suicide. The added tragedy is that these types of mental illness can be created and exacerbated by environmental exposures of young children to poverty, social and economic status, child abuse, violence or bullying.  

At a recent CityMatCH meeting, I heard a presentation that focused on suicide of children under the age of 12. I was drawn to this session because of my interest in the mental health of young children, but it also was nearly unfathomable such a study could be done of suicide in children under the age of 12 to produce a quality paper and presentation. Sadly, I was so very wrong.

According to the Centers for Disease Control and Prevention (CDC), suicide is the third leading cause of death for kids between the ages of 10 and 24 with nearly 4,600 lives lost each year. Although difficult to imagine, the suicide rate of children in and of itself is not the worst of the data. In a Morbidity and Mortality Weekly Report (MMWR) from June 2014 based on 2013 data, 39 percent of kids surveyed nationwide in grades 9-12 have either seriously considered suicide (17 percent), create a plan to commit suicide (14 percent), or have tried to take their own life one or more times within 12 months of being surveyed (8 percent). Self-inflicted injuries for children between the age of 10 and 24 at our nation's emergency rooms accounted for 157,000 treatments.

Perhaps as a precursor to the heartrending nature of these more advanced suicidal behavior figures, the same study showed that 29.9 percent of students nationwide had felt so sad or hopeless almost every day for two or more weeks in a row that they stopped doing some usual activities. Although not labeled as depression in the study, I would personally characterize extended feelings of sadness and hopelessness as such.

Although this small article is not meant to be a research brief, it would be really interesting to explore in another article any literature or research associated with the potential impact that children's depression has not just on self-harm, but on violence to others. It has always been frustrating to me that guns often commandeer the headlines after a public school shooting for example. Yet, when children who are in a mental crisis commit crimes against other children, we truly cower at addressing the root cause of the violence: diagnosing the depression and mental illness of these children and young adults well ahead of a tragedy. Too often, those headlines are buried days and weeks after but are always the same – "unfortunately, there were signs of distress in the child but no one paid attention or could help the child…"

What can be done?  Let's face it, depression in young and adolescent children is difficult to diagnose. Most parents, and many physicians, do not have the ability to carefully distinguish between a moody child going through a life phase versus a child suffering from true depression. Conduct disorders are much easier to recognize and to diagnose. Yet, there are examples of children as young as four years of age with suicidal thoughts and tendencies to harm oneself or others but so little is known that these children are often misdiagnosed with conduct disorders or treated with drug therapies that either are not helpful or exacerbate the issues.

Awareness of the issue and its prevalence is a good first step. Education and early detection of children in mental health crisis can help ease these disturbing statistics. The mental illnesses described here are prevalent within our communities. It is a true public health emergency for our children and their families. The impacts are devastating and range from grief for the death of a child (or extended casualties if outward violence is acted upon) to the long-term impacts to the families, parents, and siblings related to coping with feelings of extraordinary guilt, failure, anger, resentment, remorse, confusion and distress over unresolved issues. Sadly, there also remains a stigma surrounding suicide and child on child violence that can make it extremely difficult for survivors to deal with grief while combating feelings of isolation and condemnation from community and family.

Harkening to basic good public health practice, please give some thought to your own programs supporting children and youth and families in the context of mental health. Awareness, prevention, education – where is it that you can make a difference?

The day this article was submitted for deadline, the story resurfaced of Adam Lanza, the Sandy Hook Elementary School shooter from Newtown, CT. Unfortunately, it is another long and terribly sad commentary on a child with mental health or other challenges that often were misunderstood and misdiagnosed throughout his life. In this case, the ultimate price was 20 other innocent children and six of their educators, a mother, and Adam himself. It is my fervent hope that someday, rather than waiting for a retrospective report to be released nearly two years after a massacre of this proportion, we as a society find a way to better diagnose, treat, and create the correct systems of care for children like Adam early in their lives so that they do not suffer or put others at great risk.