The US Preventative Services Task Force — affiliated with the office of the US Surgeon General — recently took a necessary first step to address the problem by recommending that all children ages 8 and older be screened for anxiety. That’s a critical advancement, but to really help children there needs to be enough resources and support to live on the other side of any diagnoses.
A certain amount of fear is good for us; it’s why we study for that big exam, or run from a situation that feels unsafe. But some kids reach a point where their anxiety starts to get the better of them, says Jacqueline Sperling, program director of the McLean Anxiety Mastery Program at McClean Hospital, which is affiliated with Harvard Medical School.
This can manifest itself in various ways, from phobias to physical complaints or behavioral outbursts. Parents can assume that their child will outgrow it. But fear should not be dismissed as a phase. 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, every child struggling with anxiety would be referred for treatment. The catch, of course, is that while the number of mental illnesses has risen, the number of mental health practitioners has not. In 2019, the American Academy of Child and Adolescent Psychiatry found that the country needs 47 child psychiatrists for every 100,000 children, but only 9.75 per 100,000.
That’s a big reason why parents trying to find support for their child often find themselves with a long waiting list. The pandemic only drove up demand: In a survey conducted last year by Ann & Robert H. Lurie Children’s Hospital in Chicago, 18% of parents said they couldn’t find a mental or behavioral therapy provider for their child. Some couldn’t find the right person, while others said the wait was too long or the provider was too expensive.
Pediatric practices, a natural place to connect families to help, are also struggling. Between 2017 and 2018, researchers surveyed more than 1,400 practices that care for children to gauge how many children with behavioral disorders could recommend care or provide proven care — i.e., treatments known to help. Nearly all, whether treating children in a large, urban care network or a nationwide individual practice, reported some degree of challenge.
Meanwhile, schools, a critical place for struggling children, also face a dire shortage of resources. An analysis of federal data by Education Week found that nearly 40% of school districts did not have a school psychologist in the first year of the pandemic. About 44% of schools surveyed by EdWeek said their students lacked access to school mental health professionals.
A few changes could make available resources, however thinly stretched, more accessible to more families.
One obvious measure would be to improve mental health insurance coverage for children. A recent report from RAND that assessed mental health care in New York City found that a major barrier to access to mental health care was the lack of providers that accept Medicaid or even private insurance.
Another solution would be to make telehealth a permanent fixture in behavioral health services. The pandemic opened the door for virtual visits, but their future needs to be solidified – as well as more widely available and reimbursed. The telehealth option is especially important for teens who, having grown up in a digital world, may be more comfortable with that medium.
Telehealth can also make it easier for parents to connect with their children’s providers. “Their involvement in the care of the child is so critical to a successful outcome,” said Warren Ng, president of the American Academy of Child and Adolescent Psychiatry. “If we don’t work with parents and children, we’re missing half of the solution.” And on a practical level, virtual visits mean parents don’t have to miss work to take a child to an in-person appointment.
Hopefully there will also be a bigger, structural change. Child and adolescent psychiatry is investigating the most effective ways to recruit more people. And President Joe Biden’s administration made a landmark commitment last spring to improve mental health care in the country, a move that included funds intended to double the number of mental health professionals in schools.
All these efforts will pay off. But the most crucial part will be ensuring that the commitment to mental health does not waver once the memory of the pandemic fades.
After all, many past attempts to implement evidence-based behavioral health programs in schools have not had long-term support, says Colleen Cicchetti, executive director of the Center for Childhood Resilience, which is housed at Lurie Children’s Hospital in Chicago. Many programs have been funded with fragmented grants; when the money runs out, children and educators lose resources they relied on. Directors have been clear with Cicchetti that “unless you’re creating something sustainable… please don’t even bother coming.”
Parents, doctors, schools – they can all play a role in helping stop the mental health crisis in children. Identifying the children who need help is an important step. Now comes the much harder work of building a sustainable infrastructure that will keep today’s fear for children from growing into a deeper, lifelong struggle for adults.
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This column does not necessarily reflect the views of the editors or Bloomberg LP and its owners.
Lisa Jarvis is a Bloomberg Opinion columnist on biotech, healthcare and the pharmaceutical industry. She was formerly editor-in-chief of Chemical & Engineering News.
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