Washington--Despite great scientific advances over the past two decades in finding the causes and treatments for childhood mental disorders, millions of affected children in this country remain unidentified and underserved, two major studies released last week suggest.
The studies confirm the concerns of many educators, physicians, and childrens’ advocates that the mentally ill young are frequently overlooked by the health-care system or given care that is inadequate to their needs.
The study by the National Academy of Science’s Institute of Medicine estimates that there are at least 7.5 million children with mental disorders in the United States, a figure that represents 12 percent of the population under age 18. Among children from disadvantaged backgrounds, it says, as many as 20 percent have such illnesses.
Most of these children, however, have not been identified or treated, the institute found. Only 2.5 million are receiving services--some, the report says, of questionable value.
The National Mental Health Association, which conducted the second study, found “serious gaps” in the types of services available to children with mental or emotional problems. Many in need, it reported, are being inappropriately placed in residential facilities, at a cost exceeding $1 billion a year.
“Children are expected to fit into the available service system, instead of the service system being designed to adapt to the individual needs of each child,” the association’s report, the final in its “Invisible Children Project,” contends.
Both reports urge that far more money be spent on the problem, with the Institute of Medicine calling for a quadrupling of federal funding for research and training over a five-year period. The nmha study concludes that states and the federal government should triple their funding for children’s mental-health services.
“The cost of coping with these disorders is staggering,” the institute’s study says, “not only in direct payments for treatment, but also in services provided by schools, community centers, and the juvenile courts, and in emotional and financial hardship for families.”
“Simply put,” said James E. Leckman, professor of child psychiatry and pediatrics at Yale University and chairman of the committee that drafted the report, “the funding and resources are not commensurate with the size of the problem.”
‘Frustration and Optimism’
Completed by 19 scholars in the field, the Institute of Medicine’s study looked at the state of research in children’s mental health and compiled the newest information on diagnosis and treatment.
The report outlines the three major categories of childhood mental illness: emotional disturbances, such as depression and anxiety; developmental disorders that interfere with a child’s ability to think, communicate, or function effectively; and behavioral disorders--the most common affliction--which are generally manifested in antisocial and disruptive acts.
Mentally ill children often suffer from disturbances in more than one category, the report points out. And those who are left untreated frequently carry their disorders into adulthood.
The institute’s panelists found a “consistent pattern of both frustration and optimism” among researchers in the field. The frustration, they said, was due to a lack of adequate funding; the optimism, to advances being made in determining the causes of the disorders, diagnostic criteria, and relative effectiveness of treatments.
For instance, the report says, advances in both genetics and psychiatry have helped researchers establish with far greater precision the role of biology and of the environment in the development of mental disorders.
The results of these newer studies have challenged long-held assumptions about many mental illnesses. For example, autism, once seen as being caused by poor parent-child relationships, is now known to have biological roots.
Notably, the study lists social as well as biological, psychological, and environmental factors associated with childhood disturbance. “Persistent psychosocial adversity, such as poverty and homelessness, is known to increase the risk of mental illness in children,” it says.
‘Palliative’ and ‘Ineffective’
In urging more research, the institute study cites particularly the need for greater attention to evaluating treatments.
“For too many severe disorders,” it says, “available treatments are merely palliative or even ineffective.” This contrasts, the report says, with the belief by many researchers that there is “increasing reason for optimism that many of the major childhood mental disorders are responsive to treatment.”
Among the successful interventions it lists are counseling for the child, parents, entire family, and groups of children and adolescents; and preventive programs, such as parental training, that may avert future difficulties.
The report is critical of the role played thus far by the National Institute of Mental Health in stimulating research in the field. That agency, part of the National Institutes of Health within the U.S. Department of Health and Human Services, requested the report.
But it notes that while “mental-health concerns of children and adolescents have been described as a high priority at nimh,” the institute “has not been as visible a leader in relation to child and adolescent mental disorders as it has been in relation to adult mental disorders.”
To boost the national knowledge base, the report recommends that the nimh spend more money on research and on developing career paths for those interested in investigating children’s mental health.
Better Data on Chickens
The National Mental Health Association’s study examined more closely the types of services provided to mentally ill youngsters. Based on data collected from state mental-health officials and local agencies and advocates, it concludes that there is “an overreliance on more expensive and restrictive services.”
At least 4,000 children and adolescents with mental disorders, the study says, have been placed in out-of-state residential treatment facilities by state authorities, and more than 22,000 children have been placed in state hospitals for similar conditions.
“The consensus of child-care experts that community mental-health and support services and a comprehensive system of care are often more appropriate than residential placement is not widely implemented,” the study concludes.
Because states do not address the needs of these children in a “systematic way,” it says, most states have no mechanism to ensure that a child’s placement is appropriate.
“Ironically, the federal govern8ment keeps detailed information on the number and type of chickens shipped out of state on a monthly basis, but maintains no data on children shipped out of state,” the report notes.
Many of the qualitative problems associated with mental-health treatment--as well as the financial and emotional stresses on the families of children with these disorders--could be reduced, the report suggests, if states and the federal government invested more money in community-based services for troubled children.
$800,000 in Five Years
The financial and emotional toll on families trying to find and provide these services for their children was spelled out at a panel discussion here last week.
Sponsored by the mental-health association and a group of Congressional spouses interested in the problem, the panel discussion brought together parents who had been stymied by the cost of mental-health services and frustrated in their attempts to find proper treatments for their children.
Mary Jo Quinlan, a parent from a Washington suburb, said her mentally ill teenager has required services totaling $800,000 during the past five years. Ms. Quinlan said she felt fortunate because her health-insurance plan, unlike most policies, covered the cost of these treatments in full.
The interventions, however, have not been successful. Last month, only four months after her daughter’s last treatment program, the Los Angeles Police Department called Ms. Quinlan to tell her that her daughter was in their custody.
Another parent, Barbara Huff from Lawrence, Kan., described her difficulty in locating services for her daughter, who was not only anorexic, but also suffered from manic-depressive illness, a learning disability, and a kidney problem.
“By the time we had found the right services,” the daughter, Kristin, recalled, “our family had basically fallen apart.” She is 19 now and a college student.
School officials had been unsympathetic to her problems, Kristin said, and had penalized her when she had to miss school to visit her doctor.
“School was the last place supportive of us,” said the mother.
