Congress Hears Remedies For Child MH Care Crisis

Expanding early screening and treatment options for young people would lessen the chance that many children with depression or other mental illnesses will end up failing school, falling into the criminal justice system, or committing suicide, mental health advocates told members of Congress at a Capitol Hill briefing last month.

“We must bridge the gap between what we know about mental illness and what we do, even if we have to work incrementally,” said Cynthia Wainscott, chair of the National Mental Health Association's Board of Directors. She spoke on behalf of the Campaign for Mental Health Reform, a coalition of 16 organizations, including APA, whose mission is to improve access to and quality of mental health care.

“There is a tremendous individual, family, and societal burden of untreated mental disorders, yet the cost of mental health care is shifted to systems that are more costly and are not designed to provide that care,” added Larke Nahme Huang, Ph.D., of the American Institutes for Research and a member of the President's New Freedom Commission on Mental Health. “We want to catch signs of mental illness early on by involving pediatricians and primary care physicians.”

Huang described screening (with parental consent) as the closest equivalent to vaccination—a way to prevent symptoms from worsening and to improve outcomes. Children are already screened in the medical or educational systems for vision and hearing problems, tuberculosis, and lead poisoning, she said. Adding screening for mental illnesses makes sense, given that 14 percent to 20 percent of children and adolescents have such diagnoses.

Society perpetuates stigma and fails to recognize mental health as a critical part of overall health by declining to identify emotional and behavioral disorders early, she said. “Screening and early intervention are the first steps.”

All too often, an adult does not notice a child's condition until after an arrest or suicide attempt, said Wainscott, who noted that her mother and daughter have depression.

“Kids need a place to take their concerns and to overcome the reluctance, shame, and humiliation that keep them from seeking treatment,” said Boston psychiatrist Kenneth Duckworth, M.D., medical director for the National Alliance for the Mentally Ill, another member of the Campaign for Mental Health Reform. He cited the Air Force Wingman Program that trains personnel to identify signs of depression in their colleagues and makes it easy to seek treatment and discuss their concerns in confidence. Air Force officials credit the program with reducing the suicide rate there.

Duckworth endorsed efforts to expand the pool of qualified professionals to evaluate and treat young people. This means not only training more psychiatrists specializing in this age group, but also increasing the knowledge of primary care physicians in the diagnosis and treatment of mental disorders in youngsters.

A program at the University of Massachusetts now makes child psychiatrists available as “coaches” to pediatricians in the surrounding area, he said. The psychiatrists serve as consultants, available by beeper and phone within 20 minutes to 139 participating physicians, even while the young patients are visiting their offices. The child psychiatrists also conduct case conferences and grand rounds to discuss common psychiatric disorders and upgrade the pediatricians' skills in this area.

Legislative proposals should build on programs like the Massachusetts one to maximize the effectiveness of scarce resources by increasing coordination, said Wainscott. “We must prevent the negative consequences of mental disorders by getting the right services to people at the right time.”

The dearth of child and adolescent psychiatrists is compounded by a separate, underresourced mental health system that faces discrimination from payers, she said. “We still face huge hurdles in getting help to people with mental illnesses.”

More information from the briefings is posted online at<www.mhreform.org/kids.>▪