Analysis |  The United States needs five times as many child psychiatrists

Analysis | The United States needs five times as many child psychiatrists


Between falling test scores and rising rates of mental illness, American children are not doing well. Covid is an easy villain, but signs of tension appeared long before this virus took hold: Anxiety in children increased by 27% and depression by 24% between 2016 and 2019, according to data from the National Child Health Survey. Global, national and municipal studies show that the pandemic has exacerbated an already worrying trend.

The U.S. Task Force on Preventive Services – affiliated with the U.S. Office of the Surgeon General – recently took a necessary first step to addressing the problem by recommending that all children 8 and older be screened for HIV. ‘anxiety. This is a crucial step forward, but to really help children requires sufficient resources and support to live on the other side of any diagnosis.

A certain level of anxiety is good for us; this is the reason why we study for this great exam or run away from a situation that seems dangerous to us. But some children reach a point where their anxiety starts to take over, says Jacqueline Sperling, director of the McLean Anxiety Mastery program at McClean Hospital, which is affiliated with Harvard Medical School.

It can manifest in different ways, from phobias to physical symptoms or behavioral outbursts. Parents might assume that their child will grow out of it. But anxiety should not be seen as a phase. It can disrupt children’s social, family and school life, and untreated anxiety can lead to other diagnoses, such as depression, eating disorders and substance abuse.

In an ideal world, any child struggling with anxiety would be referred for treatment. The catch, of course, is that while rates of mental illness have increased, the number of mental health clinicians has not. In 2019, the American Academy of Child and Adolescent Psychiatry found that the country needed 47 child psychiatrists per 100,000 children, but only had 9.75 per 100,000.

This is one of the main reasons why parents trying to find support for their child often face a long waiting list. The pandemic has only increased demand: In a survey conducted last year by the Ann & Robert H. Lurie Children’s Hospital in Chicago, 18% of parents said they could not find a supplier mental or behavioral health care for their child. Some didn’t know how to find the right person, while others said the wait was too long or the supplier was too expensive.

Pediatricians’ offices, a natural site for connecting families to help, are also in difficulty. Between 2017 and 2018, researchers surveyed more than 1,400 practices that care for children to gauge how many might recommend or provide evidence-based care – that is, treatments known to help – for children. suffering from behavioral problems. Almost all, whether treating children in a large urban health care network or in a rural individual practice, reported some level of challenge.

Meanwhile, schools, a key location for struggling children, also face a severe lack of resources. An analysis of federal data by Education Week found that nearly 40% of school districts lacked a school psychologist in the first year of the pandemic. Some 44% of schools surveyed by EdWeek said their students do not have adequate access to school mental health professionals.

A few changes could make the resources available, however limited, more accessible to more families.

An obvious step would be to improve insurance coverage for children’s mental health services. A recent RAND report evaluating mental health services in New York found that a significant barrier to accessing mental health care was the lack of providers accepting Medicaid or even private insurance.

Another solution would be to make telehealth a permanent part of behavioral health services. The pandemic has opened the door to virtual tours, but their future needs to be solidified – while making them more widely available and reimbursable. The option of telehealth is particularly important for teenagers who, having grown up in a digital world, may be more comfortable with this medium.

Telehealth can also make it easier for parents to communicate with their children’s healthcare providers. “Their involvement in the care of the child is so critical to having a successful outcome,” says Warren Ng, president of the American Academy of Child and Adolescent Psychiatry. “When we don’t work collaboratively with parents and children, we miss half the solution.” And on a practical level, virtual visits mean parents don’t have to miss work to drive a child to an in-person appointment.

Hopefully bigger structural changes are coming as well. The field of child and adolescent psychiatry is exploring the most effective ways to recruit more people. And President Joe Biden’s administration last spring made a historic commitment to improve mental health care in the country, a move that included funding to double the number of school mental health professionals.

All these efforts will make a dent. But the most critical element will be ensuring that the commitment to mental health does not falter once the memory of the pandemic fades.

After all, many past efforts to implement evidence-based behavioral health programs in schools have not had long-term support, says Colleen Cicchetti, executive director of the Center for Childhood Resilience, which found at Lurie Children’s Hospital in Chicago. Many programs have been funded by piecemeal grants; when money runs out, children and educators lose the resources they counted on. The directors were clear with Cicchetti: “unless you’re creating something lasting…please don’t even bother to come”.

Parents, doctors, schools – all can play a role in helping stem the mental health crisis for children. Identifying children who need help is an important step. Now comes the much harder work of building an enduring infrastructure that will ensure that today’s anxiety for children does not turn into deeper, lifelong struggles for adults.

More from Bloomberg Opinion:

• Colleges should bring back testing requirements: Michael R. Bloomberg

• Paradox of the Great Depression: Children survived, then thrived: Stephen Mihm

• Trans kids don’t have the ‘regrets’ Republicans cynically claim: Lisa Jarvis

This column does not necessarily reflect the opinion of the Editorial Board or of Bloomberg LP and its owners.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, healthcare, and pharmaceuticals. Previously, she was the editor of Chemical & Engineering News.

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