Danielle Woods, 16, never would have blurted out to her family doctor that she was depressed, suicidal even.
But she was — for years — before she told her mom she “couldn’t keep doing this anymore” and ended up in a depression treatment program at Children’s Hospital.
Danielle might have gotten help sooner if someone had asked her the right questions — the premise behind a national push to get pediatricians to make mental-health screening part of annual physical checkups.
Colorado is among the states trying out “teen screens” ahead of national health care reform that will require insurance companies to cover mental illness the same way they cover physical problems.
Kaiser Permanente asked 27 pediatricians and family physicians accepting Kaiser insurance in Colorado Springs and Pueblo to begin assessing teens for mental illness a year ago. Definitive research isn’t available yet, but several doctors say they’ve been shocked at the number of A-students, high-school musicians and other high-achieving teens who checked the questionnaire box saying they’ve tried to kill themselves or considered it.
A typical screening consists of 37 questions — completed in private away from parents — about how much teens worry, whether they feel distracted and whether they enjoy hanging out with friends. The result of the seven-minute test isn’t a diagnosis, but with training, doctors can use it to discern which kids need further evaluation or immediate therapy.
“Most of the parents are very happy about this,” said Dr. Richard Spurlock, medical director for Kaiser in southern Colorado. “Sometimes these issues aren’t discussed in the school or the home.”
Kaiser, which might expand the teen screen program to Denver someday, is giving its contracted doctors in southern Colorado an extra payment each time they perform a mental-health checkup. For competitive reasons, the company would not say how much.
Annual mental-health screens for teens make sense because teenagers are more likely to have a mental illness than a physical one, said Laurie Flynn, executive director of the TeenScreen National Center at Columbia University. Suicide is the second-leading cause of teen death in Colorado, behind vehicle crashes.
“We want to make mental-health checkups available to every adolescent in America,” Flynn said. “It’s going to become the new standard of care.”
Questionnaires recommended by the center are based on decades of research at Columbia. A doctor asking, “How’s it going, Johnny? Everything all right at home?” doesn’t have the same effect as an evidence-based screen, said Flynn, whose team is training Colorado Springs and Pueblo doctors.
Teens who commit suicide typically were deeply depressed for six months or longer. “That means we have time to find them,” Flynn said.
Schools across the country, including North High and East High in Denver, have tried the teen-screen model, but experts think family doctors might have greater success. Part of the reason those Denver high schools quit using the program is that school staff needed parental permission to administer a screen, a delay that could take hours of staff time.
National research has shown that 80 percent to 90 percent of teenagers who complete the mental-health assessment are healthy, while the rest are sent to a specialist. About half of mental-health disorders begin by age 14, yet most people are diagnosed about 10 years after they first experience symptoms.
Mental-health advocates expect that federal reforms requiring insurance companies to treat mental and physical health equally will help end the stigma associated with mental illness. Still, many adults and kids with depression and other mental-health problems hide it from co-workers and friends, said Jeanne Rohner, president of Mental Health America of Colorado.
“We still have a ways to go,” she said. “We still have discrimination occurring. You can’t separate the head from the rest of the body.”
Christy Parr, mother of an 11-year-old boy in Colorado Springs, appreciated the mental-health screen her son received at a recent trip to his pediatrician. The checkups are particularly important to her because mental illness runs in the family.
“The earlier you can catch it, the easier it is to treat, just like physical problems like cancer,” Parr said. “That’s the doctor’s job — to help me if there is something that I’m missing.”
Jennifer Brown: 303-954-1593 or jenbrown@denverpost.com
