Routine screening can help families overcome barriers to receiving mental health care.
Heather Huszti, Ph.D.
By Heather Huszti, Ph.D.
Over the last two years, increasing attention has been paid to the mental health crisis that exists in the United States. It's surprising to many, even in health care, that one in five children suffer from a diagnosable mental health disorder during their childhood. And in the midst of this crisis, parents are turning to health care providers: A recent study says 77 percent of parents would first go to their family doctor or pediatrician for help when their child experiences mental health problems.
Yet, in most places there is not extensive training for doctors on how to evaluate patients for mental health problems, and many don't know where to refer children when they have mental health issues such as depression.
However, identifying and treating children early is a key to helping children live up to their full potential. Over half of all adults with persistent mental illness first experienced symptoms before the age of 14, but many waited more than 10 years for a diagnosis and treatment. In addition, pediatric patients with mental health problems and chronic illness have much higher medical care expenditures than do children with one or the other.
Routine mental health screening
In Orange County, California, Children's Hospital of Orange County (CHOC) and others in the community are working together to improve the system of care for children diagnosed with mental health conditions. One key way to better identify these children is to provide routine behavioral health screening in the pediatrician's or family physician's offices.
Children can also be screened for suicidal ideation in emergency departments. CHOC's Emergency Department (ED) began screening for suicidal ideation among all patients over 11 years old presenting to the ED for any reason. In this screening, more than 10 percent of children presenting for medical reasons also endorsed suicidal risk, much to the surprise of their parents. In each case, this allowed an opportunity to link children and families to needed mental health services.
In addition, CHOC opened an 18-bed inpatient psychiatric unit for children ages 3 through 17 years of age. We built a space that includes all private rooms, which also allows parents and caregivers the ability for 24-hour-a-day visitation. We also offer intensive therapeutic programming seven days a week. To further enhance the healing environment, the space includes a large outside recreation area, which is being well-utilized by the children. Our entire team is excited to be able to provide these much-needed inpatient beds.
Help families overcome barriers to care
While we believe screening across a variety of settings is critical, we must also have the resources for treatment available. We know offering treatment early while a child's brain is still developing is optimal, but the mental health system is fragmented at best. Specialized services for children, especially younger children, can be difficult to find. It's critical to build up this workforce as children are not small adults and there are specialized evidence-based treatments and assessments tailored to them.
Engaging families in care with a referral to an unknown provider can also present barriers. In many studies, less than half of families will make an appointment, and often only one-third actually attend an appointment with the referral. One way to address this challenge can be to have specialized mental health providers embedded in medical settings (pediatrician's offices, the Emergency Department, at the hospital) where warm hand-offs can occur.
Health care financing, however, often acts against the opportunity for warm hand-offs by not allowing payment for a mental health visit on the same day as a medical visit. Another way to address this issue is to utilize a care management approach by following up with families to assist them with overcoming barriers to accessing mental health treatment for their child, just as is being done currently with chronic medical conditions.
Finally, working on removing the stigma associated with mental health disorders, even among children, is crucial. We now understand kids' mental health is interwoven with their physical health, and both are crucial to a child's optimal functioning in childhood and into adulthood. As a society, we need to move to an understanding that #HealthisHealth and move toward a better integration of mental health screening and services into the care of pediatrics patients.
Heather Huszti, Ph.D., is chief psychologist at Children's Hospital of Orange County in California. Send questions or comments to firstname.lastname@example.org.