May is Mental Health Month, and we are facing a major crisis: a national shortage of child mental health professionals. This shortage couldn’t come at a more serious time.
More than 10 percent of children and adolescents in the United States are diagnosed with a psychiatric disorder. Many parents, fortunately, are less bothered by the stigma of mental illness and are seeking treatment for their children. Meanwhile, groundbreaking research has led to faster, better and more accurate diagnoses of psychiatric disorders in children and adolescents.
But all this has resulted in increased demand for child mental health care services. Many child psychiatrists are overloaded and unable to take on new patients. Families sometimes wait more than a year for a consultation. Consequently, kids with serious mental health issues aren’t getting the care they need.
Without timely intervention, kids and teens with mental illness are at higher risk for school failure, alcohol and drug use, teenage pregnancy, suicide, engaging in risky or criminal activities, limited or non-existent employment opportunities and poverty in adulthood. And when children with untreated mental disorders become adults, they use more health care services and incur higher health care costs than other adults. According to the National Institute of Mental Health, the cost of untreated mental illness in the U.S. is more than $100 billion each year.
In the entire United States, there are approximately 7,000 child and adolescent psychiatrists, but only about 300 child and adolescent psychiatrists complete training each year. The Bureau of Health Professions projects that by 2020, the use of child and adolescent psychiatrists will increase by 100 percent – the greatest of any medical specialty – while the number in practice will increase by only 30 percent.
Simply put, the number of trained professionals is failing to keep pace with the increasing number of children in need of mental health services. This problem is only exacerbated in rural areas, where the closest child psychiatrist may be hundreds of miles away, making it nearly impossible for rural kids to access mental health services.
Why is it so difficult to recruit new child and adolescent psychiatrists when there is such a demand for their services? Contributing factors include a decrease in federal financial support (through Medicare graduate medical education moneys) for training programs – many of which last at least five to six years, among the longest in medicine – and issues with mental health coverage by the managed care industry.
Also, some child psychiatrists, stretched thin by their clinical demands, aren’t able to devote much time to teaching, making them less-than-ideal role models for impressionable medical students.
So what can be done? Members of Congress have introduced legislation aimed at improving individual and institutional incentives for training child mental health professionals. Enactment of this law would take us one big step in the right direction, but it is not the only solution. Increasing access to care, particularly for children in rural areas, is critical, as is addressing the insurance industry’s lack of coverage of mental health treatment.
It will take a dedicated and collaborative effort of our federal government, the insurance industry, our higher education system and our nation’s academic medical centers to remove the barriers to mental health treatment for children and teenagers. Boosting the child psychiatry work force is a good place to start.
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