An Analysis of Adolescent Mental Health According to the Social Work Competencies Identified in the Council on Social Work Education.

• Author: Meier, Mary Beth
• Position: Article 1 - Essay

Mental health affects all adolescents through normal developmental or chronic life stressors, and yet, the United States fails to address emotional well-being until it manifests into a diagnosable mental health disorder that interferes with daily life activities and later success in adulthood. The alarming rate at which mental health disorders emerge, coupled with low adolescent engagement in mental health services, affirms the obligation by professionals and students in the social science field to analyze adolescent mental health using non-traditional methods. Critical analysis of existing adolescent mental health research by applying the social work competencies identified by the Council on Social Work Education (CSWE) provides an innovative framework to comprehensively assess and intervene in adolescent mental health.

Main themes from the social work practice competencies include the 1) Problem Statement, 2) Human Behavior and the Social Environment, 3) Social Work Theory and Practice, 4) Social Welfare Policy and Services, 5) Diversity, 6) Values and Ethics, 7) Social and Economic Justice, and 8) Research. Critical analysis of adolescent mental health by applying the social work competencies uncovers an urgent need to investigate the use of curriculum-based mental health interventions in the United States public school system. Following this critical analysis, a proposed research design outlines further action to be taken by professionals and students in the social science field who intend to improve adolescent mental health. Problem Statement

Going beyond the mere absence of a disorder, the World Health Organization defines mental health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her own community." (1) Currently, research indicates that one in five youth in the United States will suffer from a mental health disorder, with 50 percent of adult disorders emerging before age fourteen and 70 percent before age eighteen. (2) As adolescents transition from childhood to adulthood, they often experience normal developmental stressors or chronic life stressors that have the potential to negatively affect their emotional well-being and later prosperity in adulthood. Be that as it may, research estimates that seventy percent of youth who have a mental health need do not access mental health services. (3) The alarming rate at which mental health disorders emerge, coupled with the lack of accessing mental health services, affirms society's obligation to equip adolescents with necessary knowledge, skills, and resources. Human Behavior and the Social Environment

The most common barriers that prevent adolescents from accessing help are the high levels of stigma associated with mental health and seeking help and low levels of mental health literacy about disorders and treatment. (4) These two factors also contribute to the premature termination of mental health treatment for the thirty percent of adolescents who do seek help. (5) The theory of social stigma best explains the high levels of stigma associated with mental health and seeking help and the theory of cognitive development best explains the low levels of mental health literacy about disorders and treatment.

Erving Goffman's theory of social stigma defines stigma as a mark of disgrace attached to certain characteristics or behaviors that society labels as undesirable. (6) Internalized as early as three years old, stigma solidifies by adulthood as adolescents acquire negative attitudes and engage in social distancing from peers with mental health disorders. (7)

Stigma emerges from the interaction between "normal" adolescents and "abnormal" adolescents through the four social-cognitive processes of cues, stereotypes, prejudice, and discrimination. (8) Society identifies characteristics associated with mental health disorders, such as physical appearance, impaired social skills, or psychiatric symptoms. (9) These cues reinforce the false belief that these adolescents are "abnormal" and adopt mental health stereotypes that view adolescents as weak, incompetent, or dangerous. (10) A gap develops between adolescents' virtual social identity and actual social identity because society views these adolescents as tainted and discounted, rather than as whole and intact. (11) The adolescents' virtual social identity, or their assumed characteristics, builds on these stereotypes and may bear little resemblance to their actual social identity, or their actual characteristics. (12) With stereotypes informing adolescents' virtual social identity, society develops prejudices that lead to discriminatory behaviors as adolescents with mental health disorders interact with their social environment.

Through socialization with this detrimental environment, adolescents learn about the devaluing and discriminating perceptions of mental health. Adolescents with diagnosed mental health disorders face discredited stigma when society recognizes differences that set them apart from "normal" adolescents. (13) As a result, adolescents with diagnosed mental health disorders internalize the stigma into feelings of shame, discouragement, anger, hurt, or low self-esteem. (14) Adolescents without a diagnosed mental health disorder face discreditable stigma when society neither knows nor perceives these differences. (15) Adolescents internalize the stigma into feelings of secrecy, anxiety, disloyalty, and dishonesty as they maintain a facade of normalcy. (16) Subsequently, adolescents without a diagnosed mental health disorder engage in activities that foster acceptance among peers and the larger society.

Adolescents encountering discreditable stigma employ impression management to guard against discriminatory attitudes and behaviors. Through impression management, adolescents intentionally present themselves in a way that will be accepted by peers and the larger society. (17) Preoccupied with social image and peer acceptance, adolescents without a diagnosed mental health disorder attempt to conceal the discreditable characteristics by engaging in activities that prevent its discovery. (18) Adolescents avoid help seeking to prevent labels, discrimination, and negative emotions associated with mental health. (19) Social desirability outweighs participation in mental health services that would otherwise ameliorate the symptoms. (20)

Goffman's theory of social stigma illustrates adolescents' interaction with the self and social environment, but diversity among the population and setting influences the credibility of this theory's application. Individual factors such as age, gender, social class, race, and ethnicity affect adolescents' projection of meaning to deviant attitudes and behaviors. (21) Definitions of psychopathology vary across cultures, contexts, and time because the current environment socially constructs meaning to roles, rules, and expectations. (22) With the social environment continually evolving, the understanding of the dynamics of mental health stigma and its effect on adolescents accessing mental health services through the theory of social stigma does not remain constant, but instead depends on the meaning that the current physical and social environment attributes to mental health.

Jean Piaget's theory of cognitive development explains the dynamics of mental health literacy and its effect on adolescents accessing mental health services. The theory of cognitive development describes the intellectual abilities, mental activities, and behaviors through which adolescents attain and construct knowledge. (23) Currently, adolescents' existing cognitive structures prevent them from recognizing disorders and obtaining mental health information, knowing accurate risk factors, causes, self-treatments, and professional help, and developing attitudes that promote recognition and appropriate help seeking. (24) Adolescents with and without diagnosed mental health disorders rely on erroneous knowledge to guide interactions with their social environment.

Established during infancy and modified throughout life, schemata are cognitive structures that identify, process, and organize adolescents' environment by grouping analogous events, feelings, or images. (25) Schemata help preschool children begin to identify mental health problems in their peers. (26) While adjustments to this schema by adolescence generate an increased ability to identify a wider range of disorders, adolescents' mental health recognition still proves to be low, inconsistent, and varied by disorder; one study indicates that only 42.4 percent of adolescents correctly identify depression and only 27.5 percent of adolescents correctly identify anxiety. (27) Furthermore, adolescents use their existing schemata to falsely attribute personal blame to individuals with a mental health disorder. (28) Limited and erroneous mental health knowledge prevents adolescents from correctly modifying existing schemata that would aid in the recognition of mental health disorders and acquisition of mental health information.

When encountering unknown experiences, adolescents modify existing schemata through adaptation to better interact with their social environment by either employing assimilation or accommodation. Using the process of assimilation, adolescents incorporate and interpret novel stimuli, such as new mental health information, into existing schemata. (29) In contrast, using the process of accommodation, adolescents create new or modify existing schemata to interpret novel stimuli. (30) They tend to distort novel mental health knowledge to conform to the existing schemata, rather than adjust or create new schemata. (31) Their mental health knowledge becomes inaccurate and inconsistent, such as falsely believing that social contact, exercise, relaxation...