Doctors urged to help destigmatize childhood mental illness

Increased recognition that symptoms of many mental health conditions first appear during childhood has contributed to the growing number of doctors identifying such problems among their young patients, according to Jane M. Foy, MD.

“Certainly, there’s a greater awareness of mental health” among physicians than there has been in the past, said Dr. Foy, a professor of pediatrics at Wake Forest University School of Medicine in Winston-Salem, N.C., who chaired the American Academy of Pediatrics Task Force on Mental Health for six years.

After such a diagnosis, however, physicians often face challenges in getting patients timely care from a mental health professional due, in part, to a shortage of such specialists and a lack of coverage by health plans, mental health experts say.

The Affordable Care Act is expected to help resolve some of those obstacles by requiring coverage of mental health conditions and expanding funding for prevention, early intervention and treatment services. But barriers to adequate children’s mental health care will remain, says a new report from George Washington University in Washington, D.C.

The study was published online March 6 by the Robert Wood Johnson Foundation, which funded the research. The report is the second in a series by GWU’s Center for Health and Health Care in Schools.

The children’s mental health “system is racked not only by chronic funding shortages but also by significant challenges and disconnects between the many institutions that serve children and families,” said study co-author Julia Graham Lear, PhD.

“Policymakers, advocates and [health] service providers must work together to elevate children’s mental health on the public agenda and seek comprehensive solutions to addressing this critical public health need,” said Lear, senior adviser and founder of the GWU center.

A key role of primary care physicians is to help reduce stigma around mental illness among the patients they care for and their families, said the study’s authors.

One way to do that is to make mental health such an integral part of primary care that doctors gradually destigmatize it through their own behavior and openness about the issue, Dr. Foy said.

She encourages physicians to place informational brochures on mental health conditions and services in their waiting rooms. Dr. Foy also encourages doctors to refrain from labeling a child’s condition using medical terminology and instead use the family’s own terms to discuss the problem.

“Instead of immediately saying, ‘I think your child has a conduct disorder,’ or, ‘Your child is oppositional,’ I encourage physicians to reflect the family’s own perceptions of what the difficulty is,” Dr. Foy said.

She also suggests, when possible, that doctors incorporate a mental health professional into their practices. Doing so helps reduce the stigma of receiving mental health care and makes it more likely that the patient will follow up with the treatment recommended by the primary care physician.

“A person can park a car in front of a pediatric practice, and no one knows if they’re getting a vaccination or mental health care,” Dr. Foy said.

Prevalence of mental health problems

Forty-six percent of youths age 13 to 18 have had some form of mental health condition, according to 2010 data from the National Institute of Mental Health. Twenty-one percent of adolescents in that same age group have a serious disorder, the NIMH said.

In any given year, only 20% of youths with mental disorders are identified and receive mental health services, according to the National Alliance on Mental Illness.

For the GWU report, researchers during the summer and fall of 2011 examined programs implemented nationwide that intend to increase access to children’s mental health programs and services.

They focused on 11 states that offer a broad variance of the different types of programs being enacted. Those states are Arizona, Connecticut, Florida, Georgia, Massachusetts, Minnesota, New Mexico, North Carolina, Oregon, Texas and West Virginia.

Researchers interviewed 47 people from those states, including health professionals and representatives from governors’ offices and child advocacy organizations. They asked whether there had been recent efforts to improve services or outcomes for children and, if so, what incidents drove those changes.

They found that a critical challenge to strengthening children’s mental health programs is a lack of adequate and consistent funding largely because those services often are considered to be a low priority by policymakers. Another common obstacle is the complexity of child mental health service delivery systems and funding streams. In Georgia, for instance, public funding for children’s mental health care is associated with three distinct government systems.

While the ACA creates an opportunity to expand mental health services for children, “the undeveloped state of children’s mental health services across the United States imperils the potential success” of that effort, said lead study author Donna Behrens, MPH, RN. She is associate director of the GWU Center for Health and Health Care in Schools.

But there is reason for hope, the study authors said. They identified programs in five of the studied states where relatively new mental health policies have improved care for children.

In North Carolina, for example, the local chapter of the AAP worked with area mental health professionals and the state Division of Medical Assistance on policy changes and enhanced opportunities for collaboration among the various clinical disciplines that serve children.

One change is that primary care physicians now are permitted to provide up to 16 pediatric mental health visits for patients on Medicaid, Dr. Foy said. For as many as six of those visits, physicians can get paid without having to issue a mental health diagnosis, she added.

In the past, when a primary care doctor diagnosed a patient on Medicaid with a mental health problem, the patient had to be referred to one of the few mental health facilities that served children on Medicaid, Dr. Foy said.

“While none of the [studied] states resolved all … of the challenges in their communities,” the study authors said, “their stories remind us that there are promising opportunities to make progress in children’s mental health.”