Children with mental problems not getting the care they need.

MOST OF THE ESTIMATED SIX TO nine million children and adolescents in the United States with serious emotional disturbances are not getting the help they need, according to federal health officials, mental health experts, and mental health advocacy groups. This unmet need is coming under unprecedented scrutiny by federal health officials, professional groups, and others. Last December, US Surgeon General David Satcher released Mental Health: A Report of the Surgeon General. This 500-page publication, the first-ever Surgeon General’s report on this issue, underscores that a range of barriers make it difficult for people with mental illness—both children and adults—to receive appropriate care. Such barriers include a lack of health insurance and other financial problems, cultural stigma that discourages families from seeking care, a lack of mental health care professionals with expertise in treating children and adolescents, and a complex and fragmented mental health service delivery system. “There is broad evidence that we lack a unified infrastructure to help these children and many children are falling through the cracks,” noted Satcher in remarks at a press briefing last month. “Too often, children who are not identified as having mental health problems and who do not receive treatment enter the juvenile justice system and end up in jail. ” Experts also note that children with emotional and behavioral disorders are more likely to abuse drugs and alcohol and are at higher risk of suicide. RISING NEED, FALLING SERVICES Concern about this issue also prompted the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics (AAP), the American Psychological Association, the American Psychiatric Association, and eight other national organizations concerned with the mental health needs of children to develop a consensus statement with recommendations to address the problem. The impetus behind this cooperative effort was the recognition that although the need for mental health services has been increasing for two decades, efforts to curb health care costs have resulted in decreased availability of such services, said Joseph Hagan, MD, a Burlington, Vt, pediatrician who chairs the AAP committee on psychosocial aspects of child and family health. A recent study at the University of Pittsburgh found that between 1979 and 1996, the rate of psychosocial problems identified in the primary care setting increased dramatically, from about 7% to more than 18% of all visits to the pediatrician by 4to 15-year-olds (Pediatrics. 2000;105:1313-1321). Despite this increased recognition of such problems among children and adolescents, “it’s actually getting harder rather than easier to access mental health services,” noted Hagan. The groups outlined 20 recommendations aimed at increasing access to treatment, includingincreasingresources in both public and private sectors; establishingparitybetweenmedicalhealthservices and mental, behavioral, and substance abuse services; simplifying the process required for young patients to receive treatment; eliminating exclusions for diagnostic categories, chronic disorders, and preexisting conditions such as chronic illness; and increasing the number of qualified child mental health and substance abuse clinicians.