Building on his report on mental health, U.S. Surgeon General David Satcher, M.D., is developing a national agenda for children’s mental health that will be released in the form of a report by the end of this year.

Satcher gave the press a preview of some of the recommendations made by clinicians, researchers, parents, and educators at a landmark conference on children’s mental health last month in Washington, D.C.

"Our science, professional skills, and humanity have come together to make a powerful voice to improve the diagnosis, treatment, and recovery for children and adolescents with mental illness," said Satcher.

APA Medical Director Steven M. Mirin, M.D., commented later to Psychiatric News, "We believe that by holding this landmark conference, the Surgeon General has made a real contribution to improving the public awareness of children’s mental health problems and the need for early recognition and treatment. As we have heard, many children don’t get the treatment they need," said Mirin.

Satcher mentioned a study by conference speaker and psychiatrist Kenneth Wells, M.D., of the RAND Corporation that shows that 72 percent of 19-year-olds with behavioral disorders had symptoms in childhood.

He also quoted a Canadian participant, who said, "We have children who are casualties before they reach school age. Older children are dropping out of society because their suffering is enormous."

Many of the children in the juvenile justice system have untreated mental illnesses, added Satcher.

"We need evidence-based programs and clinical trials to test the effects of psychiatric medications in children rather than relying on physicians’ clinical experience," said Satcher.

He mentioned that the Food and Drug Administration and the National Institute of Mental Health (NIMH) are sponsoring a workshop this month to discuss regulations that apply to developing children’s medications. Satcher will incorporate the findings into his new report on children’s mental health.

Meanwhile, he announced the conferees’ preliminary recommendations on how to improve the diagnosis and treatment of children with mental illness.

• Involve teachers, parents, physicians, and mental health professionals in efforts to improve coordination of care.

• Distribute information on mental illness, especially the warning signs, to the general public and primary care physicians, parents, and teachers.

• Urge primary care physicians to develop a partnership with mental health professionals.

Kelly Kelleher, M.D., the Staunton Professor of Pediatrics and Psychiatry at the University of Pittsburgh School of Medicine, said that primary care physicians are overwhelmed by the increased volume of patients with emotional and behavioral problems.

"The number far exceeds that of any other chronic condition we treat," she commented. "Although primary care physicians are receiving some training to identify these problems, they are still frustrated by their lack of experience in treating mental and emotional disorders."

He noted that uninsured children often become enrolled in CHIP or Medicaid at some point. However, because their insurance status depends on their parent’s income, which fluctuates, it is difficult for them to receive consistent mental health services, said Kelleher.

"We need to involve insurance companies and benefit managers in efforts to improve access to care," stressed Kelleher.

Satcher said that attention deficit/hyperactivity disorder (ADHD) was a major issue discussed at the conference. The participants agreed that children who are appropriately diagnosed with ADHD and receive treatment function better than children who do not. However, many children are treated for ADHD without a thorough diagnostic assessment and input from parents and teachers. Children living in underserved inner cities and rural areas who need treatment have difficulty getting it, he said.

NIMH Director Steven Hyman, M.D., said, "When you look at children who are seriously impaired by ADHD, that figure is no more than 3 percent to 5 percent of the population. These are the kids who end up in detention because they can’t pay attention and often are hyperactive and impulsive. Their social skills are terrible, and they are rejected by their peers."

He added that children of color with mental disorders have an even tougher time gaining access to appropriate treatment, and when left untreated, they are more likely to end up in the juvenile justice system.

NIMH "is dedicated to understanding the prevalence rates of psychiatric disorders across ethnic groups and closing the gaps between what we know and what we do," said Hyman.