Responding to the requests of many affected individuals, families, and communities across the US, on April 30, 2013 President Barack Obama issued a national proclamation, designating the month of May 2013 as “National Mental Health Awareness Month 2013.” This proclamation follows on other promising signs of progress, such as an April 12, 2013 report in the NY Times about bipartisan efforts to craft new legislation that will fund more community mental health centers, provide grants to train teachers to spot early signs of mental illness, and make more Medicaid dollars available for mental health care.
As the founder of REACH, an organization founded in 2006 dedicated to increasing the availability of qualified mental health care to children, I am gratified by these initiatives. Increased public awareness and new resources are most welcome, but as a nation, we must engage in a critical, fact-based conversation about the magnitude of the challenge that we must face for our children – keeping in mind three inescapable points.
First, there is a shortage of mental health professionals who care for children and adolescents. The Surgeon General has estimated that 20 percent of the nation’s youth — nearly 15 million children — have significant behavioral or emotional conditions causing significant impairment and hindering healthy development. But our nation has a vast, insurmountable gap in the number mental health specialists needed to diagnose and treat these problems. For example, the American Academy of Child & Adolescent estimates that we have 7,400 child psychiatrists, yet this figure includes retirees, part-time practitioners, others principally treating adults, researchers or academics, and residents in training. Even accepting this optimistic estimate, all available child psychiatrists working 10-hour days are humanly incapable of serving 15 million children more than one hour per child per year. With this discrepancy in resources, how do we realistically offer the most hope and best care to children?
Second, primary care physicians hold essential keys to addressing our national workforce crisis. Despite the shortage of child and adolescent psychiatrists, another highly capable pool of experts could be drawn in, with appropriate training and ongoing support: the 58,000 pediatricians who are seeing the bulk of our children – the potential “first-responders” to whom parents often turn.
However, primary care physicians receive almost no training in childhood behavioral and emotional disturbances. Young residents preparing to enter practice are rarely mentored in diagnosing and managing conditions such as depression, trauma, aggression, or anxiety problems, among others. Some training is provided in ADHD, but studies of graduating residents and practicing physicians alike indicate that it is often inadequate – despite research showing that these types of “mental health” problems now account for the majority of chronic care visits to primary care doctor, and the bulk of childhood- and later-life impairment.
Imagine the great harm that would befall many children if their primary care doctors were not trained in asthma care, leaving it in the sole hands of limited numbers of allergists and pulmonary or infectious disease specialists. Similarly, our national shortages in child and adolescent psychiatrists, viewed in the context of children’s urgent mental health needs, must force upon us the stark reality that their needs are so widespread, urgent, and unaddressed that we, stewards of their healthy development, can no longer ignore their needs, nor the long-term consequences to them, their families, and communities.
Finally, children’s medical health, mental health and development are inseparable. We must recognize that among children, difficulties in a child’s physical health and development invariably exert effects on the child’s internal thoughts, feelings, and behavior, and vice-versa. Decades of research show that no clear demarcation exists between physical health and mental health. Nor should there be any stigma attached to emotional problems.
Since 2006 REACH has trained nearly 1300 physicians to provide high quality pediatric primary care mental health services. As a result, over these physicians’ lifetimes, more than one million children who ordinarily would not have received care will receive it, often in areas of the country where no other care is available to parents of these children. In addition to physicians, REACH has trained approximately 300 social workers, psychologists, and school counselors in evidenced-based interventions such as cognitive-behavioral therapy, thus increasing the pool of mental health professionals skilled in providing treatments that work to children and their families.
Speaking to the people of Newtown and the nation, President Barack Obama said “This is our first task — caring for our children. If we don’t get that right, we don’t get anything right. That’s how, as a society, we will be judged.”
“Can we say that we’re truly doing enough to give all the children of this country the chance they deserve to live out their lives in happiness and with purpose?”
“If we’re honest with ourselves, the answer is no. And we will have to change.”
That change must begin by helping the true “first responders” to child emotional problems —helping parents and their children’s primary care doctors (as well as teachers and school counselors) to become better equipped to hear those first cries for help, and to do something to answer them. Our successful experiences in preparing these first responders to embrace these new roles has taught us that without doubt – these urgently needed changes can begin now. Research has given us the essential tools, and sufficient willing hands stand ready to wield them, with appropriate training and support. Or must we continue to wait and watch, while more generations of children are lost?
Peter S. Jensen, MD
CEO & President
The REACH Institute
Professor of Psychiatry and Vice-Chair for Research
Mayo Clinic – Rochester, Minnesota