Adam Lanza, the Sandy Hook Elementary School shooter, is not known to have been professionally treated for mental illness. In that he was not alone. Across the country, many youth who need help the most are not getting it.
Almost two-thirds of teens with a lifetime mental disorder fail to get professional help, according to the National Institute of Mental Health. Of all those teens with mental health issues, those with severe mental disorders get treatment even less often, with half reporting they have never been seen or treated by a professional therapist.
Recent budget cuts, a shortage of mental health therapists, and inadequate community health services are among the reasons for the lack of treatment, mental health professionals say. Many health insurance plans don't cover mental health therapy. Teens and their parents are often reluctant to acknowledge the need for professional help and may not know where to turn.
The NIMH findings, which predate the tragic killings on Friday in Newtown, Conn., suggest new opportunities for action by lawmakers. Apart from the divisive issue of gun control, the fact is that mental health services are understaffed and underfunded -- and getting more so.
In the past three years, states strapped for cash have cut their funding of mental health services by $4.3 billion, according to a survey by the National Association of State Mental Health Program Directors. Nationally, that's a drop from about $41 billion a year to $36.7 billion. In response, most state mental health agencies have imposed hiring freezes and half have laid off mental health professional staff. Eight states have closed their psychiatric hospitals.
At the same time, the demand for mental health services is skyrocketing. The caseload of community mental health service providers has shot up 49 percent during the recession. The use of hospital emergency rooms for psychiatric cases has gone up 22 percent, according to the association.
"There are just a lot of people who are not getting served, and in particular those who are not insured," said Robert W. Glover, executive director of the association. Hard economic times are especially stressful, he said, causing a rise in alcohol and drug abuse, family violence, and suicide. "This is when when you need more services, not less."
With the rising demand and severe cuts in mental health funding, he said, "I've never seen it this bad in 40 years. People are ending up in jail, in emergency rooms or homeless."
Or on a murderous rampage. Lanza exploded into violence Friday, murdering his mother and then gunning down 20 first-graders and six adults at Sandy Hook. Amid the carnage at the school, Lanza fatally shot himself without leaving a note. It has since been reported that the 20-year-old had been suffering from Asperger's syndrome, an autism-like disorder. Experts have said there is no link between the condition and violence.
Ironically, one of his victims was Rachel D'Avino, a 29-year-old behavioral therapist who worked with autistic children at Sandy Hook.
Asperger's syndrome, which can be managed if treated, is not uncommon among teens. As many as one in five teenagers suffer from some forms of autism, bipolar disorder and other illness that imposes "severe impairment" across their lifetime, the NIMH reported last year. The study was drawn from lengthy face-to-face interviews in 2010 with a nationally representative sample of 10,123 teens between the ages of 13 and 18.
"The likelihood that common mental disorders in adults first emerge in childhood and adolescence highlights the need for a transition from the common focus on treatment of U.S. youth to that of prevention and early intervention," wrote the study's author, Dr. Kathleen Merikangas, a psychiatrist and senior researcher at the National Institute of Mental Health.
She did not return calls seeking further explanation.
Local community-based mental health services are often the easiest way for parents to get help. But they have been hit hard by state budget cutbacks. Last year, Glover said, 36 states reported a total cut in mental health funding of $1.3 billion, with an average reduction in each state of $35 million. That's money no longer available to pay staff and keep the lights on at local mental health clinics.
Even when professional help is available, it can be difficult for parents to get access to it.
"For example, New York City has excellent care once you go through the system," said Karestan Koenen, director of psychiatric-neurological epidemiology at Columbia University's Mailman School of Public Health. "But the system is tough to get through, and for busy, overwhelmed parents who are just trying to get by, even getting into the system may be too challenging."
For parents who struggle to help their children manage a mental health disorder, there often just isn't enough help.
"There is too much burden on the parent," Koenen said. "Schools, churches, communities need to step up and support parents who are struggling with their children."