The US Preventive Services Task Force – part of the US Surgeon General’s office – recently took the needed first step in addressing the problem by recommending that all children 8 and older be screened for anxiety. This is critical progress, but to truly help children, adequate resources and support must live on the other side of any diagnosis.
A certain level of anxiety is good for us; This is why we study for that big exam, or escape from an unsafe situation. Some kids get to a point where their anxiety starts to take over, says Jacqueline Sperling, MD, director of the McClain’s Anxiety Mastery Program at McClain Hospital, affiliated with Harvard Medical School.
This can manifest in different ways, from phobias to physical symptoms or behavioral outbursts. Parents may assume their child will grow out of it. But anxiety should not be ignored as a stage. It can interrupt children’s social, family, and academic lives, and untreated anxiety can lead to other diagnoses, such as depression, eating disorders, and substance abuse.
In an ideal world, any child with anxiety would be referred for treatment. The problem, of course, is that even as rates of mental illness have gone up, the number of mental health doctors hasn’t gone up. In 2019, the American Academy of Child and Adolescent Psychiatry found that the country needs 47 child psychiatrists per 100,000 children, yet it only has 9.75 per 100,000 children.
This is a big reason that parents trying to find support for their children often face a long waiting list. The pandemic has only increased demand: In a survey last year by Ann & Robert H. Lurie Children’s Hospital in Chicago, 18% of parents said they couldn’t find a mental or behavioral health care provider for their child. Some didn’t know how to find the right person, while others said the wait was too long or the service provider was too expensive.
Pediatricians’ offices, a natural location for connecting families for help, are also suffering. Between 2017 and 2018, researchers surveyed more than 1,400 practices caring for children to measure how many could recommend or provide evidence-based care — meaning treatments known to help — for children with behavioral health disorders. Almost all of them, whether treating children in a large urban healthcare network or a rural single practice, reported some level of challenge.
Meanwhile, schools, an important place for children who are suffering, face an acute shortage 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. About 44% of schools surveyed by EdWeek said their students did not have sufficient access to mental health professionals at school.
Some changes can make available resources, however narrow, more accessible to more families.
One obvious measure is to improve insurance coverage for children’s mental health services. A recent report from the RAND Corporation for the Evaluation of Mental Health Services in New York City found that a significant barrier to accessing mental health care is the lack of providers that accept Medicaid or even private insurance.
Another reform is to make telehealth a consistent component of behavioral health services. The pandemic opened the door to virtual visits, but their future needs to be cemented — along with making them widely available and reimbursable. The telehealth option is especially important for teens who have grown up in a digital world, and they may be more comfortable with this medium.
Telehealth can also make it easier for parents to connect with their child’s caregivers. “Their involvement in the child’s care is critical to a successful outcome,” says Warren Ng, MD, 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 a bigger structural change will come 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 landmark commitment to improving mental health care in the country, a move that included money aimed at doubling the number of mental health professionals in schools.
All of these efforts will make an impact. But the most important element will be ensuring that commitment to mental health does not diminish once the memory of the pandemic recedes.
After all, many previous efforts to implement evidence-based behavioral health programs in schools have not had long-term support, says Colleen Cecchetti, executive director of the Center for Childhood Resilience, located at Lurie Children’s Hospital in Chicago. Many programs have been funded by partial grants; When the money runs out, children and teachers lose the resources they counted on. The managers were clear with Cicchetti that “unless you’re making something sustainable… please don’t bother coming”.
Parents, doctors and schools can all play a role in helping to stop a children’s mental health crisis. Identifying children who need help is an important step. Now comes the hard work of building a sustainable infrastructure that ensures that today’s children’s anxieties don’t turn into deeper lifelong struggles for adults.
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This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Lisa Jarvis is a columnist for Bloomberg Opinion covering biotech, healthcare, and the pharmaceutical industry. Previously, she was the executive editor of Chemistry & Engineering News.
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