We Must Do Better for the Children

The importance of child and adolescent psychiatry is enormous, even for adult psychiatry. A large majority of mental illnesses seen in adults have their origins in childhood and adolescence. Early diagnosis and treatment of these disorders will thus impact their prevalence and course in adult life.

Walter Barton’s history of APA includes an excellent account of the development and growth of child psychiatry in the United States. The pioneer builder and promoter of the model interdisciplinary team in a child guidance clinic was William Healy. The American Academy of Child and Adolescent Psychiatry (AACAP) was founded in 1953. Later, child psychiatry became the first subspecialty of psychiatry to be accredited by the American Board of Psychiatry and Neurology. One of the earliest collaborations between APA and AACAP was described by Krug and Lourie in “Career Training in Child Psychiatry: Report of the Conference on Training in Child Psychiatry.” The conference was held in Washington, D.C., from January 10 to 15, 1964.

Two recent monographs (“Institute of Medicine: Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities,” 2009; and Jeste DV and Bell CC: “Prevention in Mental Health: Lifespan Perspective.” Psychiatric Clinics of North America, 2011) highlight prevention in psychiatry—in childhood and across the lifespan, respectively.

I invited Paramjit Joshi, M.D., president-elect of the American Academy of Child and Adolescent Psychiatry, to describe the current status of child and adolescent psychiatry in the United States and make recommendations for improvement. Below is her succinct summary.

Today, a staggering number of families struggle with a spectrum of conditions that affect the minds and brains of children and, if untreated, limit their ability to live happy, healthy lives. As a pediatrician and a child and adolescent psychiatrist, and as someone who has dedicated her life to children, I strongly feel that we need to think differently and shift our dialogue about children’s mental health. In medical school we were taught to think backward, to diagnose things after they occur, to cure things after they happen. But what if we flipped the model? What if we could look forward, anticipate, and intervene before disease begins? Ultimately, it is not just about keeping our children healthy, but also about creating a society of healthy adults.

As pediatricians and child and adolescent psychiatrists, we are already trained to think forward. We think developmentally: what happens at two months, four months, eight months, two years; how can we prevent, screen, and anticipate? This type of thinking has the power to revolutionize medicine—not just for children, but for all people. We have the tools to anticipate the entire future of a person’s health in childhood and intervene. Nowhere is that approach more needed than in ensuring the mental health of our children.

I propose beginning with the following steps:

Now is the time for leadership. As we form task forces, forums, and expert panels to respond to the shootings in Newtown, Conn., a discussion must take place about how we can ensure the mental health and well-being of our children. If it does not, we will have failed both the children who perished on December 14 and those who are fortunate enough to still be in our care.

The nation has a social and moral imperative to support the 1 in 5 children who need access to care. But it also has a practical imperative. Physically and mentally healthy children are more likely to become physically and mentally healthy adults. These children will grow up and enter our armed forces, our intelligence communities, our workforces, and our governments. Strengthening early access to mental health care strengthens communities and promotes stability and enables a free society.

Continued support, funding, and implementation of the following are needed: