Thursday, January 04, 2001

Kids' mental care found lacking

Surgeon general reports needs

By Tim Bonfield
The Cincinnati Enquirer

        From failing in school to winding up in jail, families nationwide are suffering because America lacks a basic mental health system for children.

        So says a report issued Wednesday by U.S. Surgeon General David Satcher.

    The Surgeon General's report lists eight goals for improving care for children with mental illness:
    • Promote public awareness of children's mental health issues and reduce stigma associated with mental illness.
    • Continue to develop scientifically proven prevention and treatment services.
    • Improve the assessment and recognition of mental health needs in children.
    • Eliminate racial, ethnic and socioeconomic disparities in access to mental health care.
    • Improve the infrastructure for children's mental health services.
    • Increase access to and coordination of quality mental health care services.
    • Train front-line providers to recognize and manage mental health issues.
    • Monitor the access to and coordination of quality mental health care services.
        “The burden of suffering experienced by children with mental health needs and their families has created a health crisis in this country,” the report states. “Growing numbers of children are suffering needlessly because their emotional, behavioral, and developmental needs are not being met by those very institutions which were explicitly created to take care of them. It is time that we as a nation took seriously the task of preventing mental health problems and treating mental illnesses in youth.”

        Nationwide, about one in 10 children suffer mental illnesses severe enough to impair their lives, but in any given year, only 20 percent of those children actually receive treatment, according to the report, “National Action Agenda on Children's Mental Health.”

        Eight goals listed in the report for improving services drew praise Wednesday from Tristate mental health experts. But some also question whether the issue will be a high priority for the incoming Bush administration.

        “It can be heartbreaking to hear the stories of these families (of children with mental illness). But what's really heartbreaking is to know we could help these kids and nobody wants to pay for it,” said Dr. William Klykylo, director of the child and adolescent psychiatry division at Wright State University. “We either need to put a lot more money into this or we've got to get better at looking the other way.”

        In Greater Cincinnati, families, pediatricians and others have been raising concerns about shortfalls in mental health services for children.

        In complex cases that require months of residential care, most local children must be sent out of town for care — often at taxpayer expense - because there aren't enough local facilities to handle the demand.

        In many less severe cases, doctors say it can take months for children to get appointments with child psychiatrists.

        Nationwide, the unmet need for child mental health services is just as deep now as it was 20 years ago, the federal report states.

        “We have spent so much time, appropriately so, on the physical health of children. In the meantime, our understanding of the social and emotional factors that provide for school readiness and for healthy development has lagged,” wrote Dr. Steven Hyman, director of the National Institute of Mental Health.

        “There is a terrifying gap between what we do know and how we act, between the services we could offer and those we offer, and between what families can afford and what families can access.”

        On the local front, the federal report is important because it points out a need for improvement at many levels, said Patrick Tribbe, president and chief executive of the Hamilton County Community Mental Health Board.

        “The child mental health system is just not as well developed as the adult system. This is an opportunity to put some of those pieces in place,” Mr. Tribbe said.

        The report's call for more coordinated care for children with complex cases resonated with James Mason, president and chief executive of Beech Acres. His agency runs Creative Connec tions, a program that arranges care for 286 of Hamilton County's most troubled teens.

        “That's exactly why my board said it wanted to invest in this program - to figure out ways to unfragment this system for the neediest kids,” Mr. Mason said.

        While the report points out many needs, it does not address the political question of how to pay for improving the system.

        “All these goals are important, but this just has not been a discussion point for the new administration,” Dr. Klykylo said. “As a profession, we are not holding our breath.”

        Dr. Satcher was appointed by President Clinton to a four-year term that expires in February 2002. Whether he will finish his term under President Bush has not been discussed, said Dr. Satcher's spokesman Damon Thompson.

        “The role of the surgeon general is to represent a non-political approach to health issues to the American people. We identify areas of need, but we leave the policy discussions to the policy makers,” Mr. Thompson said.

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