Sometimes there’s just good timing. No sooner had my last column gone to press (regarding the inadequacy of mental health services for children) than APA received a call from the White House asking me to attend a meeting with Hillary Clinton prior to a press conference she was having on March 20.

We were told that Mrs. Clinton planned to announce a major initiative in child mental health treatment concerns and wanted to meet with a small group of representatives from the major organizations involved in child mental health services. Fifteen of us met with Mrs. Clinton; Donna Shalala, Secretary of Health and Human Services; David Satcher, the Surgeon General; Steve Hyman, director of NIMH; Jane Henney, head of the FDA; and Judith Heumann, assistant secretary in the Department of Education. The meeting, and Mrs. Clinton’s initiatives, were precipitated by the recent report in the Journal of the American Medical Association, widely publicized, that stimulant and antidepressant prescriptions for preschool-aged children had skyrocketed over the previous five years.

During our meeting, Mrs. Clinton demonstrated a sophisticated and comprehensive understanding of the dilemmas and needs for children who may require mental health services. She relayed to the group, and later in her press conference, her experience working at the Yale Child Study Center while she was a law student. Her personal work experiences, she said, gave her an appreciation of the needs of children with mental health problems that she felt were invaluable.

The White House initiatives had four components: (1) improved education for parents, teachers, and health care professionals regarding the diagnosis and treatment of childhood psychiatric disorders; (2) a new NIMH multimillion-dollar collaborative study of the use of Ritalin in preschoolers with ADHD; (3) new regulations from the FDA regarding labeling for the use of psychiatric medications in small children; and, most importantly, (4) a fall conference organized by the Surgeon General for the White House on treatment for children with mental illness. (More information on these will appear in the next issue.)

It was interesting to me how the media reported the initiatives from the White House. There was an understandable focus on the potential overuse of medication, but little attention was paid to the more overriding concern that Mrs. Clinton clearly articulated: that too many children have inadequate access to sophisticated, multifocal mental health services.

While we know that more children are receiving psychotropic medications, we really don’t know why. Some have argued that it’s related to improved case finding. Others have argued that it’s the impact of managed care, with the emphasis on quick fixes from medications. Many other hypotheses have been offered, but the real need, and the approach taken by Mrs. Clinton and the National Institute of Mental Health, will be to understand the reasons for this change in prescribing patterns. It may be, as Steve Hyman said when asked whether he thought stimulants were being overprescribed, that there may be some overprescription at the same time there is some underprescription.

We were joined at the White House by the presidents of the pediatric and family practice organizations. Both presidents expressed concerns about the problems in primary care settings when primary care physicians, who may need more sophisticated training in both diagnosis and assessment as well as treatment of mental illness in children, have limited time to make treatment recommendations. Perhaps, they suggested, in that context some children may be receiving prescriptions for medications without a thorough or sophisticated diagnosis. In contrast, millions of children a year who need mental health services have no access whatsoever, and in that group there may be significant undertreatment.

I was gratified at the sophisticated approach the White House took. It would have been easy to use the report of prescription increase solely as a political football, and Mrs. Clinton clearly chose not to do that.

APA looks forward to working with the Surgeon General on this fall’s conference and to working closely with our colleagues in the American Academy of Child and Adolescent Psychiatry to ensure that the emphasis on appropriate diagnosis, treatment, and unmet needs stays firmly in the spotlight.

The timing of the White House conference was good for another reason as well. The Board of Trustees had just met over the previous few days and had ratified the tellers’ report that our corporate reorganization proposal passed. We will continue to move full-speed ahead on our course to complete our reorganization.

As you know from previous communications, a substantial amount of money has been set aside to improve public education regarding mental illness and treatment. Thus, our ability to become more visible partners in helping to educate the public regarding the unmet needs of children with mental illness will be expanded. Further, our ability to work at the local level to help ensure that states are fulfilling their obligations under Medicaid for screening of children for emotional or behavioral disturbances and to advocate in state legislatures for increased resources for child services will be clearly enhanced.

As I said, sometimes the timing is just good.