Everyone who is a front line clinician in an emergency room (ER) knows the hard reality of the lack of psychiatric services available. Discharging someone from an ER into inpatient mental health treatment is virtually nonexistent for adults. For kids, the situation is usually far worse.
The good news is that if we focus more on preventative care in school — helping kids and preschoolers long before they have a full-blown diagnosis — we may be able to stop them from ever having to use an emergency room. All we need do is start making mental health a funding priority for both the states and the federal government.
Two stories out this week help us understand the problem. The first, from Kaiser Health News via NPR, shows the real problem hospital ERs are facing:
Meanwhile, the young patients are even less likely to get reliable care after they are discharged from the ER. Whether they need regular follow-up with a psychiatrist, or a transfer to specialized facility, the resources often aren’t in place. The American Academy of Child and Adolescent Psychiatry estimates there are only 8,300 such specialists in the U.S., for more than 15 million young patients.
Dr. Lindsay Irvin, a pediatrician in San Antonio, says the dearth of psychiatrists who specialize in treating young people means many young patients simply don’t get the mental health treatment they need. By the time they wind up in the ER, she says, undiagnosed depression may have progressed to suicidal intent. And after leaving the ER, many are lost to follow-up.
America is facing a dire shortage not only of psychiatrists, but of all mental health professionals — such as child psychologists — who focus on children and teens. This shortage is playing out everyday in small towns and big cities, without regard to one’s insurance or ability to pay (although the poor shoulder the heaviest burden and the least access to services).
Until this shortage is addressed in a comprehensive manner at the national level, if your child or teenager needs immediate psychiatric care, prepare to be disappointed. You’ll likel be waiting weeks to get such care in most places in the U.S.
The federal government has not significantly increased funding for mental health services in America for over a decade. The situation is now getting dire.
Can School-Based Early Intervention Help?
Emily Goldberg, writing over at The Atlantic, suggests there is growing evidence that school-based interventions can help stop kids at risk for a future mental health problem from getting one.
The problem is — surprise! — a lack of mental health professionals:
The Substance Abuse and Mental Health Services Administration projects that 12,624 child and adolescent psychologists will be needed to meet demand by 2020, but a supply of only 8,312 is expected.
With a lack of mental-health professionals placed in schools, the responsibility to address the needs of children with social, emotional, and behavioral challenges often falls on classroom teachers. This amplifies the call to incorporate learning that focuses on students’ mental health and well-being into daily classroom activities—something that can be beneficial for all children, not just those with diagnosable conditions.
The quickest way to address this problem in the short-term (since the training pipeline is 5+ years, assuming incentives were put in place tomorrow to encourage more students to become psychologists and psychiatrists) is to get help from those already an important factor in the child’s life — their teacher.
Researchers at the Yale Child Study Center found that early-childhood and pre-k teachers who establish relationships and regularly consult with mental-health professionals were able to reduce the kind of distracting and challenging behaviors that often lead to disciplinary action for a child. In the study, published in the September issue of the Journal of the American Academy of Child and Adolescent Psychiatry, children received mental-health consultation through a statewide program in Connecticut.
As part of the program, mental-health professionals visit classrooms in which teachers or school administrators report students with particularly challenging behavior. After observing the class and visiting the child at home, assigned mental-health consultants guide teachers and parents through specific strategies to best support their students. […]
Oftentimes, the consultation process begins with identifying a student’s strengths—an essential part of finding a solution to the child’s challenges, said Linda Flach, a mental-health consultant who used a similar tactic in her work with one particular 4-year-old.
This program, successfully rolled out in Connecticut, could easily be implemented in other states as well. Of course, the state would have to fund the program — something most states are loathe to do, even if shown such funding will save them money in the long run. In fact, most states have been cutting their budgets for mental health services rather than expanding them.
We have the tools and roadmap to help fix the serious mental health problems young children and teenagers face. We lack only the will to make the resources available to help prevent mental illness before it takes hold in a young person’s life.
For more information
Kaiser Health News: How Gaps In Mental Health Care Play Out In Emergency Rooms
The Atlantic: The New Focus on Children’s Mental Health