How Should Young Men With Aggressive Streaks Be Treated?


Mass shootings have turned a spotlight on the mental health system and how it handles young, troubled males with an aggressive streak, says the New York Times. About 1 in 100 teenagers fits this category, says E. Jane Costello of Duke University School of Medicine, and they often have multiple diagnoses and are resistant to treatment. Most will never commit a violent crime, much less an atrocity. The questions of how best to help them and how to pay for it are among the most intractable problems hanging over the system. No single diagnosis fits, no drug brings real relief, and if the teenager rejects psychotherapy, there is little chance of lasting improvement.

Congress has taken steps to bring about parity for mental health, requiring insurers to cover treatments for mental illnesses as they do those for diseases like cancer and diabetes. Parents have found that, even with good insurance, they often cannot get the expensive, long-term residential treatment they believe their child needs. It is not clear how effective such treatment is. Some teens improve, but they are usually discharged to the same environment in which they got into trouble. “The problem is that, while some kids may benefit from these extremely costly services, we don't know which ones they are, and we don't have a good model for distributing those services, no matter who's paying,” said Sherry Glied of New York University.

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