Pediatric Mental Health Should Be Everyone’s Concern
May 10 is Children's Mental Health Awareness Day, and May is Mental Health Month. Today, Heather Huszti, PhD, section chief for pediatric psychology and director of training for the Psychology Training Program at CHOC Children’s in Orange County, Calif., shares why children's mental health should be important to everyone.
Over the past two years, increasing attention has been paid to the mental health crisis that exists in the United States. It is surprising to many, even in health care, that 1 in 5 children suffers from a diagnosable mental health disorder during their childhood. Even more shocking is that suicide is now the second leading cause of death among 10–14 year olds and 15–24 year olds. Most parents come to their family doctor or pediatrician when their child experiences mental health problems (77% of parents in one study stated that they would first go to their doctor for help).
Yet, in most places there is not extensive training on how to evaluate for mental health problems or where to refer children when they have mental health issues such as depression. However, identifying and treating children early is a key to helping children live up to their full potential. Over half of all adults with persistent mental illness first experienced symptoms before the age of 14, but many waited over 10 years for a diagnosis and treatment. In addition, pediatric patients with mental health problems and chronic illness have much higher medical care expenditures than do children with one or the other.
In Orange County, Calif., CHOC Children’s Hospital and others in the community have been working together to improve the system of care for children diagnosed with mental health conditions. One key way to better identify children with mental health concerns is to provide routine behavioral health screening in pediatrician’s or family physician’s offices.
In addition, children can be screened for suicidal ideation in Emergency Departments. CHOC Children’s Hospital’s Emergency Department began screening for suicidal ideation among all patients over 11 years old presenting to the ED for any reason. In this screening, over 10% of children presenting for medical reasons also endorsed suicidal risk, much to the surprise of their parents. In each case, this allowed an opportunity to link children and families to needed mental health services.
In addition, CHOC Children’s Hospital just opened an 18-bed inpatient psychiatric unit for children ages three through 17 years of age. Since this is a new unit, we were able to build a state-of-the-art space – including all private rooms, which also allows parents/caregivers the ability for 24-hour-a-day visitation. In addition, we offer the same level of intensive therapeutic programming 7 days a week. To further enhance the healing environment, we included a large outside recreation area which is being well utilized by the children. Our entire team is very excited to be able to provide these much-needed inpatient beds.
While we believe screening across a variety of settings is critical, we must have the resources for treatment available. We know that offering treatment early – when children’s brains are still developing – is optimal, but the mental health system is fragmented at best. Specialized services for children, especially younger children, can be difficult to find. It is critical to build up this workforce as children are not small adults and there are specialized evidence-based treatments and assessments tailored to them.
Engaging families in care with a referral to an unknown provider can also present barriers. In many studies, less than one-half of families will make an appointment, and often only one-third of them actually attend an appointment with the referral. One way to address this challenge can be to have specialized mental health providers embedded in medical settings (pediatrician’s offices, the Emergency Department, at the hospital) where warm hand-offs can occur.
Health care financing, however, often acts against the opportunity for warm hand-offs by not allowing payment for a mental health visit on the same day as a medical visit. Another way to address this issue is to utilize a care management approach by following up with families to assist them with overcoming barriers to accessing mental health treatment for their child – just as is being done currently with chronic medical conditions.
Finally, working on removing the stigma associated with mental health disorders – even among children – is a crucial element. We now understand that children’s mental health is interwoven with their physical health, and both are crucial to a child’s optimal functioning in childhood and into adulthood.
As a society, we need to move to an understanding that #HealthisHealth and move towards a better integration of mental health screening and services into the care of pediatric patients.