“The burden of suffering experienced by children with mental health needs and their families has created a health crisis in this country.”

• David Satcher, MD, PhD

About 20% of children in the United States suffer from at least one mental health disorder. Yet only 21% of these children are currently receiving treatment, and only 29% of children expressing suicidal thoughts in the prior year received professional help. These alarming numbers indicate that the health care system and the school system in the US are not sufficiently meeting the growing need for age-appropriate mental health and social services for children leading to inadequate diagnosis and management of these conditions. Thus, pediatricians should play an active role in improving the quality of mental health services available for children.

According to the Epidemiology of Mental Disorders in Children and Adolescents study, the most common mental health disorders for children are anxiety disorders and mood disorders, with a prevalence of 13% and 6.2% respectively and with an age of onset between 7 and 11 years. These disorders were found to have long term negative effects on the development and personal growth of children. Individuals suffering from anxiety, depression and other mental illnesses early in their lives often struggle with achieving developmental milestones, learning healthy coping mechanisms, developing social skills and building relationships. They face an increased risk of functional impairment as a result. In fact, untreated mental disorders in children are associated with higher rates of poor school performance, school dropout, social withdrawal and isolation, violence, drug abuse, juvenile detention and suicide. Thus, early identification and treatment are key steps to minimize these negative effects and improve the children’s quality of life.

High patient load and limited visit time seem to be the main challenges which pediatricians face when trying to address mental health issues for their patients. As a result, only children who present with serious behavioral changes or learning difficulties are usually screened for mental diseases and referred to a child psychologist for a more comprehensive evaluation. However, only 1 in 10 children with mental illnesses has symptoms that are severe enough to cause functional impairment at home or in school. Thus, the majority of cases go undiagnosed, and children will only receive medical attention when their conditions progress to become severe enough to interfere with their lives.

All pediatricians should be trained to detect early signs of mental health disorders in children and should be encouraged to incorporate screening questions in every well child check and sick visit. These can be simple, open-ended questions to identify any recent changes in mood, behavior, appetite or sleep pattern. Furthermore, a thorough social history is also a key in uncovering red flags or risk factors for mental health disorders. These include children with:

• unemployed parents/ low income household
• military families
• teenage parents
• foster care system placement
• juvenile system placement
• chronic diseases
• a family history of mental disorders
• a history of bullying or emotional distress

Furthermore, pediatricians should educate the public about the health care and economic burden of inadequate management of childhood mental disorders. We should work with policymakers and legislators to increase access to age-appropriate mental health resources and provide more comprehensive school-based mental health services. Pediatricians in the US should advocate for policies and strategies which enhance the quality of mental health care offered for children and consequently help them lead productive and successful lives. These include:

• Designing a screening system that permits early identification and management of high risk children both in schools and in the primary health care setting
• Providing trained and competent workforce in the school setting, including counselors and child psychologists
• Efficient coordination between pediatricians, childhood mental health specialists and teachers as well as engaging the family in the treatment plan.
• Promoting a more individualized approach of management which meets the child’s specific developmental, cultural and social needs
• Incorporating mental health care with the general practice, like having a child psychologist within the general practice setting for easy and more efficient referral
• Expanding the insurance coverage to include more mental health services like complete mental evaluation, different types of therapy and medications
• Implementing mental health prevention and stress management programs as part of the school curriculum.

 

Maryem Al Manaa, M.D.

 

Resources:

American Academy of Pediatrics: Promoting children’s mental health. https://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/Pages/mentalhealth.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

 

CDC: Children mental health.

http://www.cdc.gov/childrensmentalhealth/basics.html

 

Children mental health, what every policymaker should know. April 2010

http://www.nccp.org/publications/pub_929.html

 

School-based mental health services, 2004. http://pediatrics.aappublications.org/content/113/6/1839.full?sid=f049b524-f902-47e9-82d2-b16c3e36bec8