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Remarkable advances in brain and psychiatric research are producing effective treatments for children with mental illness. That was the message heard by legislators and their spouses and staff on Capitol Hill last month during APA’s Mental Illness Awareness Week.
APA cosponsored the annual Congressional symposium "Mental Illness Treatment: New Hope for Children" with the National Alliance on Mental Illness (NAMI).
Among those who attended were Senator Paul Wellstone (D-Minn.); Representative Marge Roukema (R-N.J.) and her husband, Richard; Representative James Walsh (R-N.Y.); Representative Lynn Rivers (D-Mich.); Karen Frist, wife of Senator Bill Frist (R-Tenn.); and Peatsy Hollings, wife of Senator Ernest Hollings (D-S.C.).
Nine legislators, including Wellstone and Roukema, also cosponsored the first depression screening on Capitol Hill.
APA Medical Director Steven Mirin, M.D., kicked off the symposium by reminding the audience of the recent passage of the Balanced Budget Act, "which includes the largest expansion of health insurance for low-income children since the enactment of Medicaid in 1965."
"This act builds upon Senate passage of the Domenici-Wellstone children’s mental health parity amendment last June, which moved us forward on our long journey toward parity in insurance benefits for those who are mentally ill and have substance abuse disorders," Mirin said.
Executive Director Laurie Flynn of the National Alliance on Mental Illness remarked, "We are proud to cohost this event to bring the good news about advances in research and treatment that you are all a part of making.
"Happily, with the leadership of the National Institute of Mental Health [NIMH], many research centers around the country, advocates in the Congress, and grass-roots networks represented here, we are seeing a new day for children and adolescents with mental disorders."
Psychiatry in the last two decades has made substantial advancements in epidemiology, diagnosis, and treatment of mental illnesses, according to Herbert Pardes, M.D., dean of the faculty of medicine and vice president for health sciences at Columbia University College of Physicians and Surgeons in New York City.
He commented that NIMH and other research agencies are putting extensive emphasis on childhood psychiatric disorders.
"We know now that psychiatric problems in children are widespread and are focusing increasingly on early detection, diagnosis, and intervention," he said.
"We want to see an aggressive attempt to focus on the disorders, to understand what their roots are, and take available diagnostic systems and treatment possibilities and strengthen them in the future."
For example, researchers are studying how to intervene and reduce the likelihood of siblings’ developing antisocial or aggressive behavior seen in an older child.
Researchers are also examining behavioral and biological aspects of suicide that may help identify teenagers at high risk, said Pardes, and there is an increasing interest in genetic factors related to childhood psychiatric disorders, including depression.
"We are starting to see data from outcomes studies on interventions for children’s disorders [that] may show the effectiveness of pharmacological therapies as well as psychological and behavioral therapies," said Pardes.
To illustrate how research advances can improve the lives of children with psychiatric disorders, Pardes introduced Andrea Eberle, M.D., a pediatrician and NAMI board member. She described her daughter’s continuing struggle with severe bipolar disorder.
"Funding of neurosciences research during the Decade of the Brain initiative has resulted in improved medications to treat Monica’s severe bipolar disorder," said Eberle. "Although she requires several medications, she has improved enough to join me in advocating for children with mental disorders."
Steven Hyman, M.D., director of NIMH, underscored Eberle’s point that "research has helped and is critical, but we have a long way to go to reach a wide number of children."
"Moreover, we have not successfully disseminated what we know. We need to understand what the incentives are for providers so we can disseminate information in a way that changes their behavior."
Hyman complained that the educational establishment is so concerned about stigmatizing children with mental illnesses "that no attempt is made to identify children who might be in need of services. We must do better with the treatments we now have in identifying children with mental disorders."
Hyman said that unrecognized problems in a child’s emotional development alter the normal trajectory of the brain and make it difficult for a child to live up to his or her potential.
During the discussion period, Hyman commented on the lack of clinical trials with children.
"The vast majority of drugs used by adults have not been tested for safety and efficacy in children," said Hyman.
The issue of children participating in clinical trials is complicated by ethical considerations around informed consent.
"The research community as an advocacy community must seriously weigh the safety and rights of people against the progress and discoveries research has made," Hyman said.
Former APA president Jerry Wiener, M.D., the Leon Yochelson Professor of Psychiatry at George Washington University Medical School, remarked on the outstanding progress psychiatry has made in the last 35 years, especially in the area of research in diagnosis and treatment.
"Moreover, extraordinary and increasing efforts of patient and advocacy groups have helped destigmatize mental illness in adults and children through education," Wiener said.
He recognized NAMI’s Flynn and Michael Faenza, executive director of the Mental Health America, for their tireless advocacy efforts.