The Road to Independence: Addressing the Needs of Adolescents and Young Adults with a Serious Mental Illness

Diagnosed with schizo-affective disorder, Tom has spent most of his teen years in and out of psychiatric hospitals. He was living with his mother, who was unable to provide the support and guidance he needed, and at age 17 was about to age out of the children’s mental health system. Yet he did not have the tools that prepared him for independence and the transition to the adult mental health system. Due to his hospitalizations, he regularly missed school for long periods, and as a result did not graduate from high school or create any friendships. He had no work skills, and as he saw it, no future.

Tom was referred to The Mental Health Association of Westchester County, Inc. (MHA)’s Crossroads program which serves Westchester residents aged 17.5 to 22 years who meet the New York State Office of Mental Health criteria for a serious mental illness (SMI). The only program of its kind in Westchester County, Crossroads provides developmentally appropriate services specifically designed for youth like Tom, who are considered adults, but do not have the skills, education or financial stability to live independently. Since many of these young adults cannot afford to travel, or having lived with a mental health “label” for years, are reluctant to come to a mental health clinic, Crossroads provides counseling and support in the home and in the community. Crossroads is one of the only programs to provide mobile services to this population and it is crucial to its success. Services are also provided at one of MHA’s licensed mental health clinics.

The period from adolescence to adulthood is challenging, even more so for older teens who are struggling with a serious emotional disturbance or severe mental illness. Crossroads participants are returning to the community from a residential treatment facility, hospitalization, foster care and other living situations and are usually from families who need support. Like Tom, these young adults typically have high rates of school absenteeism and difficulties completing high school due to disruptions caused by their mental illness, such as psychiatric hospitalizations and family problems. In Crossroads, approximately 50% of young adults in Crossroads do not have a GED or high school diploma upon entering the program. Other issues they confront are a lack of skills to live independently and to establish and maintain supportive relationships; limited facility with problem solving; poor decision-making skills; limited impulse control; and difficulty in developing work skills. In addition, many have developmental delays.

On their own, they are frequently unable to successfully continue their education or secure employment. Transition-age youth with a diagnosis of a serious emotional disturbance (SED) or SMI have higher rates of substance abuse than any other age groups with mental illness and are three times more likely to be involved in criminal activity than those without an illness. In addition, serious mental health conditions in adolescence generally continue into adulthood and young adulthood is also a high-risk period for developing new disorders. (Seeking Effective Solutions: Partnerships for Youth Transition Initiative (PYT), June 2007, These young adults have the same goals as their peers who do not have a mental illness: They want to attend and finish school, obtain a job and have meaningful relationships. When asked their priorities for assistance, youth with a diagnosis of SED/SMI identify finishing school and career training; securing a decent job; learning independent living skills; managing and living within a budget; finding an affordable, safe and comfortable home; and coping with their family issues. (ibid)

Established more than 15 years ago, Crossroads has proven its effectiveness in providing mental health and support services to this underserved sector of Westchester’s population. The program has created a strong network of collaboration with other service providers and is perceived as a leader in the community in addressing the mental health needs of this population.

Studies show that programs like Crossroads, which provide continuity of care and developmentally appropriate services can improve outcomes for young people with a SED/SMI. Over time, these young people are more likely to be employed and to be pursuing high school or post-secondary education. They are less likely to drop out of high school and less likely to experience interference in their lives from their mental health conditions or from drug or alcohol abuse. (ibid)

Crossroads’ multi-disciplined team of licensed clinicians, case managers, and psychiatrist help these young adults move toward self-sufficiency and economic security by providing a full range of mental health treatment and case management services. Both Intensive Case Management with four visits per month, and Supportive Case Management, two visits per month are provided. Therapy sessions are available weekly and psychiatric services are generally provided on a monthly basis. All services can be provided more often as clinically indicated.

With the case manager, each Crossroads client establishes two or three long-term goals that become the basis for the Service Plan that guides services and identifies the individual’s strengths and possible barriers to achieving goals. The program strives to empower these young adults, normalize their lives through connections to social and peer support programs, and help them to navigate systems by themselves.

Crossroads respects the young adult’s developmentally appropriate need for greater independence and greater control over goals, services and life decisions. For Tom, that meant his case manager did not give up when he wouldn’t stay in a GED program, or insist that he accept an apartment in a supportive housing program when he said that he wasn’t ready. Over time, Tom achieved success. His case manager connected him with a peer support program which provided him with acceptance and friends who understood his experiences. No longer isolated, his confidence improved. He obtained his GED and is now enrolled in a community college and is a leader in the peer support program. Though still living at home, he now can see a future. He is interested in a career in human services and has told his case manager that he is ready for greater independence. With his case manager’s support, he obtained a leaner’s permit – a milestone that most youth take for granted, but one that is a crucial step to self-sufficiency for Tom.

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