The US needs 5 times as many child psychiatrists

Between declining test scores and rising rates of mental illness, America’s children are not doing well. COVID-19 is an easy villain, but signs of the strain were emerging long before the virus took hold: Anxiety in children increased by 27% and depression by 24% between 2016 and 2019, according to data from the National Survey of Children’s Health . Global, national and city-level studies show that the pandemic has exacerbated an already worrying trend.

The US Preventive Services Task Force – affiliated with the US Surgeon General’s office – recently took a necessary first step in addressing the problem by recommending that all children 8 and older be screened for anxiety. It’s a key advance, but to really help children, they need enough resources and support to live on the other side of all the diagnoses.

Some level of anxiety is good for us; it’s the reason we study for that big exam or run away from a situation that feels unsafe. But some kids reach a point where their anxiety starts to take over, says Jacqueline Sperling, program director of the McLean Anxiety Mastery Program at McLean Hospital, which is affiliated with Harvard Medical School.

It can manifest in a variety of ways, from phobias to physical symptoms or behavioral outbursts. Parents might assume that their child will grow out of it. But anxiety should not be dismissed as a phase. It can disrupt children’s social, family, and academic lives, and untreated anxiety can lead to other diagnoses, such as depression, eating disorders, and substance abuse.

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In an ideal world, every child struggling with anxiety would be referred for treatment. The catch, of course, is that while rates of mental illness have increased, the number of mental health practitioners has not. In 2019, the American Academy of Child and Adolescent Psychiatry found that the country needs 47 child psychiatrists for every 100,000 children, but only has 9.75 per 100,000.

That’s a big reason parents trying to find support for their child often find themselves on a long waiting list. The pandemic has only increased demand: In a survey conducted last year by Ann and Robert H. Lurie in Chicago, 18% of parents said they could not find a mental health or behavioral health care provider for their child. Some did not know how to find the right person, while others said the wait was too long or the service provider was too expensive.

Pediatricians’ offices, a natural place to connect families for help, are also struggling. Between 2017 and 2018, researchers surveyed more than 1,400 childcare practices to measure how many were likely to recommend or provide evidence-based care — meaning treatments known to help — to children with behavioral disorders. Almost all of them, whether treating children in a large, urban health care network or a rural individual practice, reported some level of challenge.

Meanwhile, schools, a critical place for struggling children, also face a huge lack of resources. An analysis of federal data by Education Week found that nearly 40% of school districts lacked a school psychologist in the first year of the pandemic. About 44% of schools surveyed by EdWeek said their students do not have adequate access to school mental health professionals.

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A few changes could make available resources, however thinly expanded, more accessible to more families.

One obvious measure would be to improve insurance coverage for children’s mental health services. A recent Rand report evaluating mental health services in New York found that a significant barrier to accessing mental health care is the lack of providers who accept Medicaid or even private insurance.

Another solution would be to make telehealth a permanent fixture in behavioral health services. The pandemic has opened the door to virtual visits, but their future needs to be solidified – along with making them more widely available and returnable. The telehealth option is especially important for teenagers who, having grown up in a digital world, may feel more comfortable with that medium.

Telehealth can also make it easier for parents to connect with their children’s providers. “Their involvement in the child’s care is so critical to having a successful outcome,” says Warren Ng, president of the American Academy of Child and Adolescent Psychiatry. “When we don’t work in collaboration with parents and children, we’re missing half the solution.” And on a practical level, virtual visits mean that parents don’t have to miss work to take their child to an appointment in person.

Hopefully a bigger, structural change is coming. The field of child and adolescent psychiatry is investigating the most effective ways to recruit more people. And President Joe Biden’s administration last spring made a landmark commitment to improving mental health care in the country, a move that included funding to double the number of school mental health professionals.

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All these efforts will make a dent. But the most critical component will be ensuring that commitment to mental health does not waver once the memory of the pandemic recedes.

Ultimately, many past efforts to implement evidence-based behavioral health programs in schools lacked long-term support, says Colin Cicchetti, executive director of the Center for Child Resilience, which is based at Lurie Children’s Hospital in Chicago. Many programs are funded by individual grants; when money runs out, children and educators lose the resources they’ve come to rely on. The executives were clear with Cicchetti that “unless you’re creating something sustainable … don’t even bother coming.”

Parents, doctors, schools—all can play a role in helping prevent childhood mental health crises. Identifying children who need help is an important step. Now comes the much harder work of building a sustainable infrastructure that will ensure today’s angst among children does not escalate into deeper, lifelong struggles for adults.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotechnology, healthcare and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News. This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

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