Why Does Serious Mental Illness in Young Adults Get Missed So Often?

Here are two pretty powerful facts about mental illness: Most serious mental illnesses—seriously debilitating conditions like schizophrenia and psychosis—start when people are in their teens or as young adults. If they're caught and treated very early, the severity of the illness can often be curbed.

That's why it's painful to hear that a wide range of people—doctors, parents, teachers, and the victims themselves—so often miss the early signs of mental illness during these young years, thus failing to get them prompt medical treatment and leading to much worse financial and social costs as the illness goes untreated.

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That point was made in a recent study, published in the journal Social Psychiatry and Psychiatric Epidemiology. Researchers at McGill University in Canada looked at information from health and social service providers to identify people ages 14 to 25 who’d been diagnosed with schizophrenia or a psychosis for the first time. They then examined whether those same people had had any mental healthcare in the four years prior to their first diagnosis.

What they found was disturbing: Nearly one-third of patients had no prior mental healthcare before being diagnosed with a full-blown disorder. Almost half of the young people were first diagnosed in an emergency room. Yet the chances are very good that in the majority of these cases, early signs were there—if they had been picked up. While the study was done in Canada, there’s no reason to believe that young people in the U.S. aren’t experiencing something quite similar.

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In particular, primary care doctors, who may be seeing young people for other medical needs, are in a good position to do a better job of spotting mental health issues earlier on. Signs that something serious may be wrong include a depressed mood, anxiety, poor sleep, social withdrawal, odd behavior, suspiciousness, irritability, and simply not being able to cope with daily functioning, the study authors noted.

In one study, almost half of young people with a serious mental illness were first diagnosed in an ER.

But primary care doctors may need to receive more training if we want them to find more mental health issues sooner. Some physicians, for example, may confuse signs of psychosis with depression or anxiety and prescribe medications such as antidepressants, which will not help a patient with psychosis and can even make the illness worse. A doctor may also wait too long to refer a patient to a psychiatrist.

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But the problem may lie, too, with patients and the healthcare system, says Rebecca Fuhrer, a co-author of the study and professor in the department of epidemiology, biostatistics, and occupational health, McGill University Faculty of Medicine, in Montreal. "That primary care providers may miss the signs of psychosis is only one explanation," she says. "It could also be that patients refuse referral to psychiatric services due to the stigma of mental illness, or that primary care physicians are unable to arrange a referral to more specialized care due to gaps in the healthcare system."

The importance of early detection of mental illness cannot be understated. Studies have shown that the more treatment is delayed after a first episode of psychosis, the worse a patient typically does later, notes Fuhrer. "These patients tend to have symptoms that are more difficult to treat and a poorer level of functioning and quality of life."

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In the United States, people without health insurance are particularly at risk, of course. The Affordable Care Act contains provisions designed to improve coverage of mental health conditions, so the law could open the door to swifter diagnosis and treatment.

Still, some people with signs of mental illness are unable to get specialized mental healthcare because many psychiatrists—who typically treat more severe mental illness like schizophrenia—these days refuse to take health insurance. That leaves ill people in the hands of doctors who aren’t equipped to treat these complex and often very debilitating conditions. To make matters worse, there’s also a severe shortage of child and adolescent psychiatrists in the U.S., according to numerous studies.

Should medical schools train every student on how to spot early signs of mental illness? What else could be done to help people with schizophrenia and other severe conditions get diagnosed and treated sooner?

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• Rates of Mental Illness in America are Persistently High

Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.