Mental health and illness in Boston's children and adolescents: one city's experience and its implications for mental health policy makers.

In 1999, the Boston Public Heath Commission used data from a variety of sources to explore the level of mental health disturbance in Boston's children and adolescents. Data for 1997 from the Youth Risk Behavior Survey showed that about 20% of Boston public high school students had ever experienced suicidal ideation, while approximately 10% had actually attempted suicide. About one in five teenage respondents to the Boston Youth Survey said they were frequently depressed. While females were more likely to report depression, males were more likely to report isolation and less likely to consider counseling. Medicaid claims data revealed differences by gender and age, with males using psychiatric emergency and Medicaid mental health services more than females, and 10- to 15-year-olds using these services more than other age groups. Emergency room injury surveillance and death certificate data indicated that among children and adolescents, females were twice as likely to attempt suicide as males, although males were more likely to complete a suicide. This data analysis helped pinpoint areas of need and has proven useful in the development of a child and adolescent mental health action agenda. Efforts to date have included expansion of surveillance, legislative advocacy, coalition building, and new services. Key indicators including suicidal ideation and attempts, service utilization, and service capacity have been chosen as markers for future improvement.