Adolescent mental health: Challenges with maternal noncompliance

Abstract

The leading cause of suicide ideation, attempts, and completion in adolescents is persistent and unresolved parental conflict. National statistics show extremely high rates of childhood neglect and abuse are perpetrated most often by single mothers. Psychiatric disorders arising from maternal–child dysfunction are well-documented. However, resources to prevent offspring victimization are lacking. Here, we report maternal neglect of a 15-year-old male brought to the psychiatric emergency room for suicidal ideation. An inpatient treatment plan including pharmacotherapy, family therapy and psychological testing was initiated. The patient’s mother failed to attend clinic appointments or family therapy sessions. Clinician attempts to engage the mother in the treatment plan was met with verbal assaults, aggression, and threatening behavior. The patient decompensated in relation to the mother’s actions. Child Protective Services were contacted and a follow-up assessment with the patient and mother is pending. Psychiatric treatment of the mother may be a necessary intervention and prevention regimen for both the adolescent and the mother. Without consistent Child Protective Services oversight, medical and psychosocial follow-up, the prognosis and quality of life for this adolescent is considered very poor. Stringent mental health law and institutional policies are needed to adequately intercede and protect adolescents with mental illness.

An evidence synthesis of risk identification, assessment and management for young people using tier 4 inpatient child and adolescent mental health services

“…Eight studies (reported in 10 items) used a qualitative approach, 175-184 four used an experimental design 127,173,174 and 15 a non-experimental design. 128,142,[185][186][187][188][189][190][191][192][193][194][195][196][197] Four (reported in five items) were reports of large-scale projects that used a variety of methods, 11,15,[198][199][200] two were published journal articles describing local initiatives and practice 143,220 and five were clinical case reports [221][222][223][224][225] of young people's journeys into, through and out of the system where the less obvious risks were considered.…”

“…127,142,143,173,174,177,178,182,[185][186][187][188][189][190][191][193][194][195][196]220,223,224 Ten studies reported in 12 items were conducted in the UK. 11,15,175,176,[179][180][181]183,[198][199][200]221 Two studies were conducted in Finland 95,184 and two in Canada.…”

“…The majority of studies (n = 34) were conducted in inpatient settings 11,15,127,128,142,143,173,[175][176][177][178][179][180][181][182][183][184][185][186][187][188][190][191][192][195][196][197][198][199][200][220][221][222][223][224][225] and four were conducted within RTCs in the USA. 174,189,193,194 Length of stay…”

“…143,[173][174][175][176][183][184][185]188,190,191,[198][199][200][220][221][222][223][224][225] Of the remaining studies, short inpatient stays (< 1 month) were recorded in six (and reported in seven) studies: median 6 days; 186 mean 5. …”

“…127,128,142,143,174,175,[179][180][181][182]185,[188][189][190]192,193,195,197,200,[220][221][222][223][224][225] Four of these studies reported on the care of one young person only, the ages of the young people participating being 13, 221 15, 222 15 223 and 16 years.…”