Fourteen million American children have a mental health disorder, but most insurance plans don't adequately cover mental health, and policy makers have different ideas on how to best address this problem. We spoke to Parents advisor Harold S. Koplewicz, MD, child psychiatrist and director of the New York University Child Study Center, about what he thinks is needed -- and why.
How can we improve mental health care for children in this country?
A. We need to start by recognizing that mental health is as important as physical health. Many parents think we're overmedicating kids and over-psychologizing their problems. But the majority of children with mental illness aren't getting any help -- and left untreated, their disorders only get worse.
Are there specific policy changes we need?
A. One thing that we desperately need is parity for mental health in insurance coverage. That means all insurers should be required to cover psychiatric services in the same way they cover physical illnesses. Some leaders in Congress are trying to make that happen, and there has been some progress. But we still have a long way to go. Another thing: This election season, we're hearing a lot of talk about universal health care. If it's truly universal, mental health has to be included.
Is it cost-effective for insurance companies to cover mental health?
A. Psychiatric and learning disorders cost us billions of dollars a year in lost workdays, disability, Medicaid, juvenile-court costs, and lost taxes. We know that 75 percent of all adult psychiatric disorders start during childhood and adolescence. If we address these disorders from the start, they're going to be a lot cheaper and easier to treat.
Is there a disparity in treatment between the rich and poor?
A. Poorer kids are less likely to get treated, because there are fewer services in their communities and there's more of a stigma attached to mental health problems. That said, Medicaid does cover treatment for children, so the very poor are covered. And the very rich can afford to pay for treatment. It's the working class and the middle class that are left out.
What would it take to identify these sorts of disorders earlier?
A. We need to make mental health screening as prevalent as hearing and vision screening. We need to incorporate assessments in preschool, in childcare, and in the juvenile justice system.
Is it a pediatrician's responsibility to look for mental health disorders?
A. Pediatricians are clearly first in the line of defense. There are only 6,300 practicing child psychiatrists in America. And if pediatricians know what to look for, mental illness can be caught earlier. Autism can be identified as early as 18 months. But change won't happen until the federal government gets involved.
Do you see any reasons to be optimistic?
A. There have been exciting scientific breakthroughs that may help us diagnose disorders earlier. Researchers are using brain imaging to identify specific brain circuits that appear to be at the core of ADHD. They are also working on studies of social phobia, generalized anxiety disorder, autism, and Asperger's syndrome. But we need more federal funds for research.
What can we do to support research?
A. We need the federal government to give more money to hospitals willing to train child psychiatrists in separate departments (just as we have separate pediatrics departments) and pay for them to do research. That's something that we've been discussing with people in Congress. Hospitals need to get extra reimbursements for residents training in child psychiatry.
By the Numbers: Statistics You Should Know
20: The percentage of children and teens in the U.S. who have a psychiatric disorder.
76: The percent of increase in the suicide rate for teenage girls in the past year.
50: The estimated percentage of kids with ADHD who are never diagnosed.
400: The percent of increase in diagnoses of bipolar disorder in children in the past decade.
113: Billions of dollars the U.S. loses a year because of untreated and mistreated mental illness.
Common Kid Mental Disorders
The most prevalent mental health problem, affecting 13 percent of 9- to 17-year-olds. While all children experience some anxiety, severe anxiety -- extreme fear of social settings, school, or separating from parents -- requires medical treatment.
Attention Deficit/Hyperactivity Disorder (ADHD)
Five to 10 percent of children have this disorder, which is marked by trouble paying attention and concentrating.
As many as one in 33 children may be clinically depressed. The rate among adolescents is closer to one in eight. Kids who have depression may feel helpless and hopeless, but they are also irritable, lethargic, and moody, and often withdraw socially.
About 20 percent of all kids have a learning disorder. These disabilities occur when the nervous system can't receive, process, or communicate information properly.
Children who have difficulty obeying rules and who act inappropriately in public may suffer from this behavioral and emotional disorder, which affects 10 percent of kids.
About 3 percent of teenage girls have an eating disorder such as anorexia nervosa, bulimia, or binge eating.
Call to Action: Print out a form letter to send to your elected officials urging them to support mental health parity. Congress has taken some steps to require insurance companies to improve coverage of psychiatric care, but more action is needed. Your support can make a difference.
Copyright © 2008. Used with permission from the May 2008 issue of Parents magazine.
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