Caring for Young Adults With Mental Illness

To the Editor: Services that are clinically and developmentally specific to young adults with mental illness (and chemical dependence) are essential, as noted by Robert Giugliano (1) in the Open Forum in the April issue (1). Although we agree with much of what Dr. Giugliano recommends, we take issue with his advocacy for establishing a bureau for young adults. This idea appears to be the product of an underlying assumption that having a bureau means achieving results. Partitioning off one age group from another can unintentionally splinter and compartmentalize services and funding. In addition, a highly delimited bureau can create transition problems for patients and agencies after the seven years elapse between the ages of 18 and 25 years—and many young adult patients would be in the system for less than seven years before having to make the transition.

Our approach in New York City does not rely on a bureau. Instead, we identify need, engage in effective planning, and support advocacy for needed services, and on the basis of these efforts we direct funding for populations in need.

Dr. Sederer is executive deputy commissioner of the division of mental hygiene services in the New York Department of Mental Health and Hygiene.