Pandemic. Mental health. Kids in crisis. Doomsday headlines have become commonplace over the past 2 years. The “grownups” are all tired, drained, overwhelmed. So just imagine what it’s like for the kids and adolescents. What has happened to them during the COVID-19 pandemic? And what was happening even before COVID?
In October 2021, three groups concerned with child health — the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP), and the Children’s Hospital Association (CHA) — declared a national emergency in children’s mental health. Numbers don’t lie: According to the US Centers for Disease Control and Prevention, between March 2020 and October 2020, emergency visits for children rose nearly 25% for 5- to 11-year-olds and 30% for 12- to 17-year-olds. Suicide attempts specifically in girls ages 12-17 increased 50% in early 2021. Eating disorders have skyrocketed in adolescents. Almost 150,000 children have lost a primary or secondary caregiver due to death from COVID.
But for those of us in pediatrics, this news is not shocking or, frankly, even news.
As physicians, we committed ourselves to helping our fellow humans as well as being lifelong learners. So why are child/adolescent mental health disorders the leprosy of pediatric medicine? Again, numbers don’t lie: These disorders affect almost 20 million children, and only about 1 in 10 receive adequate treatment. Would our society allow this if childhood cancer or autism had such dismal treatment rates? Undoubtedly not.
I have taken care of enough of these kids to see the warrior spirit inside them and their families as they fight with insurance companies, fight the associated stigma, fight the ignorance surrounding many of these illnesses. These kids and families don’t give up, despite the barriers and obstacles. Just like a parent whose child has cancer or chronic medical problems doesn’t give up.
The difference is that generally those families don’t spend hours fighting insurance companies and there is no associated stigma. People create CaringBridge sites and GoFundMe pages to support the families, and most physicians treat them with compassion. Ask most parents of kids with mental illness about the support they get. They’ll tell you that the typical line is an ignorant comment like “Why don’t they just snap out of it?” in the case of adolescent depression, or “Why doesn’t she just eat?” in the case of eating disorders.
Physicians are afraid of children and adolescents with mental health issues or mental illness when parents bring them for help. This fear is largely a reflection of their lack of knowledge and experience in recognizing and treating these kids, as well as the stigma that persists that these children are raging, out of control, or “crazy.”
There are simply not enough child and adolescent psychiatrists who are fellowship trained to keep up with the overwhelming needs of these children. This phenomenon is not new. In 2001, the AACAP organized a task force to try to increase the numbers. It failed. According to the academy, the United States currently has a total of 8300 practicing child and adolescent psychiatrists (CAPs).
Unfortunately, nearly 1 in 5 children in the country are diagnosed with some type of mental/behavioral/emotional disorder. Sadly, only about 1 in 10 receive adequate treatment. Even more shocking is that, according to the AACAP’s workforce maps, not a single state in the entire country has a “mostly sufficient supply” of CAPs (defined as at least 47 per 100,000 children). Most have a “severe shortage” (defined as 1-17 per 100,000 children). As expected, children in rural areas and other underrepresented demographics have even fewer opportunities for adequate diagnosis and/or treatment.
No doubt it is encouraging to see dominant child organizations like the AAP, AACAP, and CHA now lending a voice to the kids and families whose voices or struggles are rarely heard. In a perfect world, their advocacy and weight would mean that every child with a mental — or brain-based — illness would be diagnosed in a timely fashion and receive treatment to appropriate outcome. The reality is … different. Change is not likely to happen unless those of us in the trenches work to achieve it.
What do we do as physicians to combat this crisis? Do we say, “I can’t get paid fairly and keep my practice running if I take care of these kids”? Do we worry that “I don’t have any expertise in child/adolescent psychiatry to prescribe meds, recognize worsening symptoms, etc.”? Is this what happens when a patient presents with atypical symptoms? Is this what occurs when a patient doesn’t respond to standard treatments? The answer is — or should be — a resounding “No!” Should it be any different with mental illness?
Our children and adolescents with mental illness need the same compassion, diligence in obtaining knowledge and expertise, and warrior spirit that we devote to other diseases. Mental health is health. Mental health care is for all kids. I challenge my fellow physicians to treat it as such. The kids need it, families need it, our world needs it, and all kids deserve it!
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About Dr Ann Contrucci
Ann L. Contrucci, MD, is a board-certified pediatrician with almost 30 years’ clinical experience. She has practiced rural and suburban primary care as well as urban and suburban pediatric emergency medicine throughout her career. She also had her own solo practice in Ontario, Canada. She is currently an Assistant Professor of Pediatrics in the Clinical Education Department at Philadelphia College of Osteopathic Medicine. Her particular areas of expertise and passion include mental and emotional health issues in children and adolescents, in particular anxiety, emotional dysregulation, and eating disorders.