Today’s post is the first in a series on Hot Topics in Children’s Mental Health we’ll be doing in May in recognition of Mental Health Month, National Children’s Mental Health Awareness Week (May 6-12), and and National Children’s Mental Health Awareness Day. We’ll start by taking a look at some reasons why families often experience great frustration in obtaining effective treatment for their children with mental health disorders.

Shortly after launching this blog, I wrote a post entitled Church, We’ve Got a Problem following the publication of a government-funded study reporting that 22% of children entering first grade met criteria for at least one mental health disorder. Serving kids with mental health issues and their families wouldn’t be such a big problem for churches if more kids were receiving more effective treatment. Sadly, that’s not the case.

Much has already been written about the challenges families face in obtaining an appointment for a child or teen with an appropriately trained and qualified mental health professional. Here’s an interesting study examining access to mental health care for kids on a state-by-state basis. Unfortunately, it says nothing about the effectiveness of the services provided.

I’m in my 21st year as a practicing child and adolescent psychiatrist following completion of residency and fellowship training. Because of the nature of my practice, the majority of families I see have received services from other mental health practitioners prior to my initial evaluation. Keeping in mind that I have a biased sample (these families wouldn’t be coming to our office if their child had responded positively during prior attempts at treatment), I never cease to be amazed by the experiences families report to me when I’m taking a history of their child’s previous episodes of care.

I see several recurring themes among patients who present to our practice after having received unsuccessful treatment elsewhere…

• There often appears to be an inadequate understanding of the causes of the child’s presenting problem(s) by the professionals treating the child…or at the very least, a failure to communicate that understanding effectively to the child’s parents.

• When medication is a component of the child’s treatment plan, the parents and the child often demonstrate little knowledge of why medication is being prescribed, the rationale for using a specific medication, the anticipated benefits of medication and the time frame in which the benefits of medication might be observed. I’ve also observed that healthcare professionals often fail to appreciate the extent to which medication-related side effects complicate the lives of the kids they treat.

• Kids often receive ineffective treatments (psychological and/or medical) for long periods of time without anyone involved…parent or professional…regularly questioning the course of treatment.

Reflecting upon these observations, one barrier to kids receiving effective mental health care is that parents often lack an appreciation of the standard of care they should expect for their children. Another barrier is that many parents don’t know the right questions to ask to ensure that their kids get the treatment they need. Parents may be intimidated by the prospect of questioning professionals about their child’s care, especially when access to other qualified professionals is limited by geography or finances. An additional reality is that too many professionals treating kids aren’t especially competent or effective, but continue because the need is so great and alternatives are scarce in many communities.

Recommended resources:

Here’s a download from NAMI’s Child and Adolescent Action Center…Getting an Accurate Diagnosis for Your Child: 10 Steps for Families.

Here’s a Facts for Families download from the American Academy of Child and Adolescent Psychiatry on questions for parents to ask about psychiatric medication.

Here’s a fact sheet from the National Institute of Mental Health on Frequently Asked Questions About Treatment of Children  With Mental Illnesses.

Next: How money influences the mental health care our kids receive…