People between the ages of 18 and 25 are the most likely of any age group to experience mental illness. They’re also the least likely age group to get adequate services, and often have difficulty navigating the complex transformation into adulthood known as “the transition cliff.”
Ana lives in one of those unassuming buildings peppered throughout Chicago that don’t quite look like the homes and apartments surrounding them. These are assisted living facilities. She’s been living here with her cat, Snowball, and a handful of other adults with mental illness for a few years.
ANA: I turned 21 on a Sunday, and that Friday I was emancipated from DCFS. I had no guardian; I was my own guardian. I knew I wasn’t going to have anymore help. I was scared when I was put into my own apartment because thought I was going to end up doing something really bad to myself.
Ana’s diagnosis is borderline personality disorder, depression, chronic PTSD and schizoaffective disorder. Since she was 13, she’s bounced between dozens of hospitals and nursing homes. Ana has family in Chicago, but none she could turn to for help.
ANA: Unfortunately my dad doesn’t believe in mental illness so it’s kind of hard to talk to him. He doesn’t believe I need medication. He has a thing about throwing my pills in the garbage and I have to go scavenge hunting after them. It’s hard to make him comprehend I can’t help it – he thinks I do it on purpose.
Ana says her dad didn’t believe her mom’s mental illness was legitimate, either. Her mom is schizophrenic.
ANA: Unfortunately she jumped off 7th floor building, and crushed her leg. She’s permanently in a wheelchair. I just learned this last year. My family kept that from me. Before that I thought my mom was dead.
Her mother is now living in an assisted care facility in Texas. Ana arrived at her facility with the help of Thresholds. Her supplemental security income – or SSI – pays the rent. She’s been doing well here, even holding down part time jobs at Radio Shack and Target. But she wants more.
ANA: I don’t want to be here such a long time, you know? There are people here who’ve been here 10 years, 13 years, you know? And I don’t want to do that. I don’t want to be here the rest of my life.
Mark Fagan is the associate director of youth programs at Thresholds. The non-profit mental health agency provides treatment and housing.
FAGAN: With our state in Illinois, we know that it’s increasingly very seriously difficult to get any kind of mental health services if you don’t have really good insurance or if you don’t have Medicaid.
He says even though the law says adulthood starts at 18, insurance and Medicaid coverage don’t necessary follow that marker. So Fagan says that young adults experiencing a mental health condition tend not to qualify for those services at exactly when they need it the most.
Adding to that problem is the fact that the mental healthcare system is designed for independent adults or for dependent children. There’s not much out there for those who fall in between.
Vanessa Vorhies is a researcher who works with young adults at Thresholds. She says that research shows that true adulthood actually starts around 30 years old.
VORHIES: You know if we think about any other developmental phase across a lifespan - this one is what I find is most interesting - is the amount of change. The young people tend to move a lot, they tend to be under a lot of stress because they have to pick college or a career or something. And you can become a parent. Also young people are most likely to get or develop serious mental health conditions during this time.
Because hormonal changes affect brain development, many disorders don’t physiologically show up until these in between ages. By the time these symptoms are identified, Fagan says the services that match with them don’t follow along, and that’s where we get into what we call a “transition cliff.”
COREY: Being honest you know, independence is hard.
Corey is 21 years old. He suffers from schizophrenia and lives with his family in Roscoe Village.
COREY: My family thought that it was like a phase or a funk - that it would go away eventually. But unfortunately it didn't happen and they decided I needed professional help.
Corey is lucky to have parents that recognized his illness and who still want him to keep living with them. Because many parents, after years of incredible difficulty raising a child with illness, are overwhelmed to the point of saying, “You know what? You’re 18 – you’re on your own.”
COREY: One of my pills was $400. Another was $200. Two of them were over $100. Pills are very expensive, that's why people need health insurance.
While his family offers emotional support, he says they’re not in a position to fully support him financially. Corey’s monthly cost of medication comes to nearly $1,000. And like so many navigating insurance beaurocracy, he had a lapse in services.
COREY: We have Medicaid, and then they sent me a notice in the mail that at 19 they cut me off my insurance, but they never gave me a chance to apply for my own medical card. I didn’t have insurance for a month and a half. I had to pay for my medications completely and medications are so expensive. I completely broke the bank, I had no money in my account whatsoever.
Shannon Garrison is a therapist working with Corey and many other young adults at C4 Chicago. She says she sees gaps in services like his all the time.
GARRISON: I’m still trying to figure out how this process works because there doesn't seem to be rhyme or reason. I have quite a few clients that have the same mental health diagnosis, the same kind of delays or deficits in functioning and one has gotten approved for a medical card, and has gotten approved for SSI, but a kid in a similar situation can't get either one.
With this lack of medication and therapy, Garrison says young adults end up back in the hospital, or worse.
GARRISON: So it actually ends up costing more without these services because you're going to see a lot higher rates in psychiatric institutions and in unfortunately the criminal justice system.
Garrison’s program, just like the other rare programs like it across the state, lost a $100,000 dollar grant to fund their young adult services. They had been teaching scores of struggling youth everything from balancing a checkbook to job readiness. And it’s dealing with some of that daily grind that makes life so hard for people like Corey.
COREY: Ever since my mental disorder, when I’m stressed out, I get under pressure I do have little breakdowns. I get angry, I cry. I just feel like if I still went back to school I’m afraid I couldn’t finish because to this day I still crack down under pressure.
Both Corey and Ana have had it rough. But in a way, they’re fortunate – because they found help. Studies show that about one out of every five youth has a diagnosable mental health disorder. And of those – 70 percent never get treatment. Consider this: If one in five Chicago public school students had an undiagnosed mental disorder, there would be more than 57,000 ill children without mental health care in this city alone.
Corey and Ana’s lives illustrate just a few ways in which this phase of life is treacherous. Despite advances in medicine and therapy, the immense social stigma of mental health conditions remain immune to science. In considering everything, it’s easy to feel hopeless. But Mark Fagan, who we heard from a while back, says the very instability of this period is actually where there’s hope, too.
FAGAN: Young adulthood is also a time where we’re able to have some pretty serious influence. You know often times their brains are not fully developed and that’s what’s great. Because we still have that opportunity to provide some influence in terms of both their biological structure as well as their social and emotional structure. So even though it’s an incredibly difficult time, it also provides us with a lot of opportunity for hope and support and for the ability to create healthy transitions along their lifetime.
What are your hopes for the future?
ANA: I want to become a social worker or therapist. I want to be someone that helps other people.
COREY: I don't want to throw my life away - I have dreams for myself.