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Children's Mental Health--A Public Health Crisis?

A new government report that came out this morning describes the current state of children's mental health care as a public health crisis, and outlines a national action agenda to combat the problems. Children's mental health is an all-too-familiar subject these days, from teen suicide to school shootings. The US Surgeon General Dr. David Satcher is in Washington D.C. to tell us more.

Interview with Dr. David Satcher, US Surgeon General

This report is the result of a lot of interaction and dialogue between parents, patients and health care practitioners sharing their insights and experiences when it comes to kids and mental health. The Surgeon General says he was surprised by the magnitude of the problem and the lack of access to services. Many people said that access to services is as bad now as it was twenty-five years ago.

Kids aged from infants through to adolescence are all affected, suffering from everything from ADHD to depression. The numbers are staggering, 14 million children are afflicted with mental illness each year, half of them suffering some kind of impairment, and of those less than two million get treatment.

Satcher sees the solution starting with increased public awareness of the issues and better coordination of the fragmented system. Children often get caught up in the system and shunted to the wrong part as a solution. An example would be a child who ends up in jail rather than receiving counseling.

He also believes that along with research into diagnosis and treatment for conditions, the question of whether our knowledge translates into available services needs to be asked. We need to constantly train and update frontline providers in detection and treatment advances.

As far as public awareness efforts, Satcher says he hopes the release of this report will increase public dialogue about children's mental health issues. Government agencies also need to work with community groups and fund programs to increase awareness and promote research.

It is important to increase acceptance of mental health issues, because a major hurdle to overcome is the stigma attached to mental problems. This stigma impacts individuals and families who don't want to admit a problem and therefore don't feel comfortable seeking help. It stifles families who wonder if it's actually a positive move to seek help in the face of a disapproving society. A favorable environment needs to be fostered in the community. Stigma also affects policy-making, and a favorable public opinion will lead to better public policy when it comes to children and mental health.

We need to educate parents, teachers and other caregivers about potential problem areas in children's mental health. There are a lot of stories about the problems that no one recognized prior to the development of mental illness. We need to improve not only the system of care, but also the flow of information within the system.

Of all people in societ, parents are perhaps in the best position to notice changes related to mental illness. Changes in personality or inappropriate reactions or behavior are potential warning signs. Parents should not ignore them, but instead ask their pediatrician about the behavior. They can then coordinate with other caregivers like teachers or coaches to observe the child, and compare notes in order to provide an accurate diagnosis. It should be the responsibility of all caregivers to observe and monitor children regardless of a pre-existing condition... all should take notice and take action if they perceive a potential problem.

As far as the government funding that is necessary to implement the action agenda, Satcher says he believes that the financial infrastructure needs to be there to accomplish the goals set forth. "We'll pay one way or another as a society in terms of health care or criminal justice when it's too late to prevent the problems related to the underlying mental illness."

What's in the report

Today's report describes a public crisis in mental health for kids and adolescents, and outlines goals and strategies to improve services. The National Action Agenda identifies eight goals and multiple action steps, which include promoting public awareness of children's mental health issues, reducing the stigma associated with mental illness and improving the assessment and recognition of mental health needs in children.

The report identifies a fragmented system wherein even problems that are identified often go untreated due to lack of an infrastructure geared towards children.

The agenda also encourages the adoption of science-based prevention and treatment services as well as continued research into children's mental health issues. According to the report, bridging the gap between research and practice is not the only step, connecting research and practice to policy is critical in meshing available treatments and services, and therefore ensuring quality care.

The report calls for an increase in the coordination of mental health care services for families with mental health care needs. At present, there exists no primary mental health care system for children. Despite the existence of mental health programs in many communities, the nation lacks a basic mental health care infrastructure. Treatments and services are fragmented across many institutions, ranging from schools to primary care to child welfare - and often the juvenile justice system. Moreover, disparities in access exist across racial, ethnic and socioeconomic groups. Multiple systems of health care can be difficult to navigate, and in many cases the services are simply not there.

The report reflects the culmination of a series of activities over the past year, and synthesizes recommendations from three major federal agencies: the Department of Health and Human Services, the Department of Education and the Department of Justice. A broad cross-section ocitizens, health care providers and community-based organizations also contributed.

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