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  • Ask an Expert: Children's Mental Health Care

  • Gregory Fritz, MD, director of the Bradley/Hasbro Children's Research Center and president-elect of the American Academy of Child and Adolescent Psychiatry (AACAP), answers questions posed by the public about mental health.

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    What are today’s pressing issues in children's mental health?
    The biggest issue remains access to care. As healthcare reform leads to more people having insurance, and as stigma continues to decline, the demand for mental health services will increase. Currently only one in five children with a diagnosable psychiatric disorder receives treatment, so there are many children in need. The mental health workforce and infrastructure cannot meet the current need, to say nothing of increased demand. We all need to come to terms with the magnitude of the problem.

    How can we solve the problem of lack of access to care?
    The solutions to the problem are multiple; no single change will come close to addressing it.

    • We need to expand the workforce by encouraging and incentivizing more young people to train as psychiatrists, psychologists and other child mental health professionals. Loan repayment programs, currently under consideration in congress, are an example of such encouragement.
    • We need to help those in primary care and education become more effective at recognizing and addressing mental health issues. This means educational programs for pediatricians, advanced practice nurses, and other professionals. as well as offering access to readily available consultations with mental health professionals on challenging cases so that they feel confident in applying skills they have learned.
    • We need to develop more efficient ways to utilize scarce mental health professionals, especially child and adolescent psychiatrists. An example of this is telepsychiatry in which technology is utilized to provide individual evaluations at a distance, often to remote rural areas.
    • We need to use other sophisticated technology to replace or support professional time. Computer screening for psychiatric disorders in physician waiting rooms, automated reminders to take medication, and games to "exercise" vulnerable parts of the brain are all available or in final stages of development.

    What role do parents play in their child’s mental health?
    Parents need to be aware of the high prevalence of psychological disorders in children and not let stigma blind them to seeing problems in their own child. Treatment is much easier and more effective when it’s applied early.

    Parents need to be assertive advocates for their children's mental health around issues such as bullying, inappropriate contact from predatory adults, content of children's media, etc. Parents should be aware that their influence on and responsibility for their child's healthy development is primary; teachers, coaches, pediatricians and other professionals can assist, but no one can replace a parent in shaping a child's development. That means that parents must be actively involved in such things as monitoring children's computer use, looking out for signs of substance abuse, and setting appropriate limits.

    Their own behavior provides a powerful model for their children; the best advice can't undo poor parental examples.

    What role do pediatricians play in children’s mental health?
    Pediatricians need to demand adequate training, reimbursement and psychiatric support for their work with children's mental health problems. Obtaining that, they need to embrace their role as front line professionals, actively pursuing effective screening, early intervention and creative collaborations with mental health professionals.

    I feel it’s important that every pediatrician have a strong, formalized relationship with an individual child and adolescent psychiatrist and a pediatric psychologist for coordinated referrals and consultations.

    What role do educators play in their students’ mental health?
    Educators, like pediatricians, are on the front lines of children's mental health. Too frequently these days, "zero tolerance" policies can lead to referrals to emergency departments for issues that can better be handled in an appropriate outpatient or early intervention program, before a child reaches a true emergency.

    Educators would help better meet the needs of their students by joining with mental health professionals to create less costly, more useful alternatives to the emergency departments.

    What can the general public do to advance the knowledge of children’s mental health?
    Everyone needs to consciously work to reduce the stigma of mental illness. Lack of equality between the medical and mental health insurance benefits still exists despite being outlawed by the Parity Law in 2008. This inequality for those with mental illness is a devastating blow to the mental health community and only keeps us further from removing the stigma around mental illness.

    I'd like to see everyone ask their local, state and national representatives where they stand on mental health issues; no matter the outcome, such open discussion would go far to reduce stigma.

    What are your goals as president-elect of AACAP?
    I just took office as the president-elect with a two-year period to get a running start for my two years as president. I see that office as an opportunity to influence mental health policy and health care reform as the ACA rolls out.

    My decades of working on the boundary between pediatrics and child psychiatry, both in research and clinical practice, make me especially interested in the process of integrating mental health and medical care.

    I hope to work with leaders in both disciplines to promote comprehensive, coordinated care.

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