Need for Child Psychiatrists Gets Congressional Attention

Senate legislation introduced in June would create financial incentives for medical students and residents to become child psychiatrists and for child psychiatry training programs to increase their recruitment and enrollment.

The measure (S 1572) and an identical House bill (HR 2073) would also provide similar f inancial incent ives for individuals to become child mental health professionals, defined by the bill as psychologists, school psychologists, psychiatric nurses, school social workers, marriage and family therapists, school counselors, and professional counselors. The Child Health Care Crisis Relief Act of 2007 is sponsored by Sens. Jeff Bingaman (D-N.M.) and Susan Collins (R-Maine).

“Clearly something needs to be done to address this serious shortage of mental health professionals to meet the growing needs of our nation's youth,” Bingaman said on the Senate floor. “This bill creates incentives to help recruit and retain mental health professionals providing direct clinical care and to help create, expand, and improve programs to train child mental health professionals.”

The legislation offers an incentive to physicians to become child psychiatrists and receive debt assistance through a federal loan-forgiveness program. The federal government would repay part or all of a physician's graduate medical education loans on the condition that the physician, upon completing the child psychiatry residency or fellowship, would work full time treating children who meet the priority criteria established by the legislation.

The criteria concern children with serious emotional disturbances, children who come from racial or ethnic minorities, and children who live in urban or rural areas with shortages of child psychiatrists and child mental health professionals.

To address national and local shortages, the legislation also would increase the number of residents in child psychiatry by extending Medicare reimbursement for graduate medical education for two years after general psychiatry training.

The tremendous need for child and adolescent psychiatrists in rural areas is seen in states such as New Mexico, Bingaman said, where there is 1 psychiatrist for every 20,000 residents, compared with 1 per 3,000 residents in urban areas. In rural areas, he said, it is not unusual for the parents of a child in need of services to travel 60 to 90 miles to reach the nearest psychiatrist, psychologist, or other mental health provider.

The nationwide need for more psychiatrists and mental health workers is illustrated by the federal government's current designation of more than 1,600 urban, suburban, and rural communities as Mental Health Professional Shortage Areas due to their severe shortage of psychiatrists, psychologists, social workers, and other professionals to serve children and adults. The need also was illustrated by the Council on Graduate Medical Education, a committee of the Department of Health and Human Services, which concluded in 1990 that 30,000 child and adolescent psychiatrists were needed. There are fewer than 8,000 such clinicians today.

The 1999 Surgeon General's Report on Mental Health estimated that more than 13.7 million children and adolescents needed treatment for mental illness but less than 20 percent received it.

“The lack of children's mental health specialists is a major impediment to treatment for thousands of children and adolescents with mental illnesses,” said Thomas Anders, M.D., president of the American Academy of Child and Adolescent Psychiatry, in a statement. “The legislation will increase this crucial workforce and thereby provide better access to care. It needs to be passed this year.”

The measure is more likely to advance than similar previous efforts because supporters plan to attach it to a reauthorization bill for the State Children's Health Insurance Program (SCHIP), which has broad, bipartisan support.

“That's just one option, but right now that's the best option,” said Lizbet Boroughs, deputy director of APA's Department of Government Relations.

The Senate bill's supporters are waiting until committees agree on a final SCHIP bill to emerge from various competing versions—likely in July—before they push to have the measure included in that legislation.

The House measure, sponsored by Reps. Patrick Kennedy (D-R.I.) and Ileana Ros-Lehtinen (R-Fla.), is not expected to begin moving through the committee process until after the August recess.

The legislation, which has been introduced in the two previous congressional sessions, is estimated to cost $45 million annually. It would require an appropriations bill allocation, which would not come until spring 2008 at the earliest.

The text of the Child Health Care Crisis Relief Act of 2007 can be accessed at<http://thomas.loc.gov> by searching on its bill numbers, HR 2073 and S 1572. ▪