A Meaningful Future for Young People with Mental Illness
Transitioning to adulthood is a daunting task for most young people -- it can include striving to graduate from high school; finding a full-time job or entering college; living independently; forming long-term relationships and becoming a parent. Although their goals and desires may be the same as those of their peers, young people who have a mental illness or substance use disorder, especially those who are transitioning from institutional care, face an even more challenging road. For the many youths who reside in residential treatment facilities or foster homes, turning 21 can feel like falling off a cliff.
A recent U.S. Government Accountability Office report (2008) outlined the many challenges facing approximately 2.4 million non-institutionalized young people, ages 18 to 26, who have serious mental illnesses [http://www.thenationalcouncil.org/cs/overview] and are transitioning from child to adult delivery systems of care. The report, which excludes children who are homeless, in foster care, or in the juvenile or criminal justice systems, nevertheless identified significant hurdles in obtaining housing, health and mental health treatment, and employment. The young people GAO studied are far less likely than their peers to graduate from high school (64% versus 83%) or to enter college (32% versus 51%).
Although the GAO report raises important policy issues that should be addressed by states and the federal government, the study has serious gaps. For example, it failed to include the young people most at risk for chronic homelessness or incarceration, those who may have the most difficult time transitioning: young people with a mental illness, regardless of diagnosis, who are institutionalized or already living on the streets.
The GAO study focused on the public service system; that is the formal services and supports kids receive as they go from one birthday to the next. Various program eligibility rules differ drastically for children and adults. One in four children receiving SSI will fail to qualify as adults. Similar problems occur with Medicaid. The report also noted the failure of adult programs to address the unique needs of young adults: What 24-yearold wants to spend time in group therapy where the average age of the other participants is 47? These important problems must be addressed, but meager income supports and formal mental health treatment can only do so much to guide a young person through both the morass of public programs and the overwhelming daily challenges of life as an adult.
For young people with serious mental illness to succeed in the adult world, they need more than treatment. They need to be truly integrated into their communities. They need jobs that offer skills, dignity, independence, and peers. And they need a responsible and caring older adult who can help them make better choices, learn from their mistakes, and applaud their successes, no matter how small.
National mental health organizations, as community providers, can create those opportunities through their own programs or appropriate community collaborations. The Children's Village in Westchester, New York, which serves foster children in a residential treatment center, is an example worthy of mention. The Children's Village created a transition-age youth program, Work Appreciation for Youth (WAY), for kids who are at the highest risk of incarceration, homelessness, and joblessness. The program starts in the residential facility and continues for 5 years after the youths enter the community.
The core elements of the WAY program for transitioning youths are as follows: Educational advocacy and tutoring to facilitate school success; work experiences and work ethics training to enable participants to build work histories and a sense of themselves as workers; group activities and workshops to promote a positive peer culture and help youth develop life skills; and financial incentives to help youth plan, save, and believe in their futures; and long-term, individualized counseling/ mentoring to help WAY participants meet challenges and solve problems.
The counseling and mentoring component is not an "add-on" service or a volunteer program. Each young person is assigned a paid, trained WAY counselor, and their relationship forms the core of the WAY experience, providing personal and intensive emotional support and practical guidance at every step of the way in the youth's young adulthood. Counselors are to be coaches, cheerleaders, surrogate parents, advocates, teachers, and friends. Most important, counselors stick with the young people during the worst times, no matter how far off track they get.
Community mental health organizations like WAY focus on education, job preparation, and the professional counselor has been effective in changing the expected paths for many young people. Compared with their peers, participants in these therapy programs are much more likely to stay in or complete educational programs, be employed, and avoid involvement in the criminal justice system. Ninety-five percent of the young adults who have completed the WAY program were in school, employed, or had obtained a high school diploma or the equivalent.
Vinfen, a community mental health organization in Cambridge, Massachusetts, is another example of a community provider working to address the unique needs of youths with mental illnesses as they transition to adulthood. Vinfen uses the evidence supported Transition to Independence Process model (TIP) developed by the National Center on Youth Transition at the University of South Florida. The TIP system promotes independence using a trained facilitator/mentor to assist youths in developing and implementing their own educational, career and independent living goals. The facilitator works with each youth to identify and strengthen a social support network that can include family, friends and other caring and responsible adults.
Vinfen acknowledges that using a self-determination model like TIP to assist transition-age youths requires acceptance of some risk on behalf of providers and state agencies. We know that young adults are not in the best position developmentally to make the best decisions and that decision making is influenced by the many negative experiences youths may have in their families (e.g., death of a parent or caregiver and abuse or neglect), in foster care and while institutionalized, or in detention. It is the facilitator's job to assist young people in seeing a different future for themselves--a future that may include a high school diploma and college; a full-time job and a vocation; a safe and stable living situation; and healthy, enjoyable relationships.
Although transition-age youths with mental illness may always need traditional mental health services, treatment alone is not enough to ensure that "system kids" will make a successful transition to community life as adults. Organizations like the Children's Village and Vinfen have demonstrated the importance of providing trained adults to help young people set and meet the kinds of goals we have for all children: that they live happy and productive lives, as independently as possible, surrounded by supportive people who love them.
A recent U.S. Government Accountability Office report (2008) outlined the many challenges facing approximately 2.4 million non-institutionalized young people, ages 18 to 26, who have serious mental illnesses [http://www.thenationalcouncil.org/cs/overview] and are transitioning from child to adult delivery systems of care. The report, which excludes children who are homeless, in foster care, or in the juvenile or criminal justice systems, nevertheless identified significant hurdles in obtaining housing, health and mental health treatment, and employment. The young people GAO studied are far less likely than their peers to graduate from high school (64% versus 83%) or to enter college (32% versus 51%).
Although the GAO report raises important policy issues that should be addressed by states and the federal government, the study has serious gaps. For example, it failed to include the young people most at risk for chronic homelessness or incarceration, those who may have the most difficult time transitioning: young people with a mental illness, regardless of diagnosis, who are institutionalized or already living on the streets.
The GAO study focused on the public service system; that is the formal services and supports kids receive as they go from one birthday to the next. Various program eligibility rules differ drastically for children and adults. One in four children receiving SSI will fail to qualify as adults. Similar problems occur with Medicaid. The report also noted the failure of adult programs to address the unique needs of young adults: What 24-yearold wants to spend time in group therapy where the average age of the other participants is 47? These important problems must be addressed, but meager income supports and formal mental health treatment can only do so much to guide a young person through both the morass of public programs and the overwhelming daily challenges of life as an adult.
For young people with serious mental illness to succeed in the adult world, they need more than treatment. They need to be truly integrated into their communities. They need jobs that offer skills, dignity, independence, and peers. And they need a responsible and caring older adult who can help them make better choices, learn from their mistakes, and applaud their successes, no matter how small.
National mental health organizations, as community providers, can create those opportunities through their own programs or appropriate community collaborations. The Children's Village in Westchester, New York, which serves foster children in a residential treatment center, is an example worthy of mention. The Children's Village created a transition-age youth program, Work Appreciation for Youth (WAY), for kids who are at the highest risk of incarceration, homelessness, and joblessness. The program starts in the residential facility and continues for 5 years after the youths enter the community.
The core elements of the WAY program for transitioning youths are as follows: Educational advocacy and tutoring to facilitate school success; work experiences and work ethics training to enable participants to build work histories and a sense of themselves as workers; group activities and workshops to promote a positive peer culture and help youth develop life skills; and financial incentives to help youth plan, save, and believe in their futures; and long-term, individualized counseling/ mentoring to help WAY participants meet challenges and solve problems.
The counseling and mentoring component is not an "add-on" service or a volunteer program. Each young person is assigned a paid, trained WAY counselor, and their relationship forms the core of the WAY experience, providing personal and intensive emotional support and practical guidance at every step of the way in the youth's young adulthood. Counselors are to be coaches, cheerleaders, surrogate parents, advocates, teachers, and friends. Most important, counselors stick with the young people during the worst times, no matter how far off track they get.
Community mental health organizations like WAY focus on education, job preparation, and the professional counselor has been effective in changing the expected paths for many young people. Compared with their peers, participants in these therapy programs are much more likely to stay in or complete educational programs, be employed, and avoid involvement in the criminal justice system. Ninety-five percent of the young adults who have completed the WAY program were in school, employed, or had obtained a high school diploma or the equivalent.
Vinfen, a community mental health organization in Cambridge, Massachusetts, is another example of a community provider working to address the unique needs of youths with mental illnesses as they transition to adulthood. Vinfen uses the evidence supported Transition to Independence Process model (TIP) developed by the National Center on Youth Transition at the University of South Florida. The TIP system promotes independence using a trained facilitator/mentor to assist youths in developing and implementing their own educational, career and independent living goals. The facilitator works with each youth to identify and strengthen a social support network that can include family, friends and other caring and responsible adults.
Vinfen acknowledges that using a self-determination model like TIP to assist transition-age youths requires acceptance of some risk on behalf of providers and state agencies. We know that young adults are not in the best position developmentally to make the best decisions and that decision making is influenced by the many negative experiences youths may have in their families (e.g., death of a parent or caregiver and abuse or neglect), in foster care and while institutionalized, or in detention. It is the facilitator's job to assist young people in seeing a different future for themselves--a future that may include a high school diploma and college; a full-time job and a vocation; a safe and stable living situation; and healthy, enjoyable relationships.
Although transition-age youths with mental illness may always need traditional mental health services, treatment alone is not enough to ensure that "system kids" will make a successful transition to community life as adults. Organizations like the Children's Village and Vinfen have demonstrated the importance of providing trained adults to help young people set and meet the kinds of goals we have for all children: that they live happy and productive lives, as independently as possible, surrounded by supportive people who love them.
