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APA commended the bipartisan Congressional Children's Caucus for focusing on the mental health treatment needs of children, adolescents, and their families at a hearing last month on Capitol Hill.
"APA and its members have long advocated for improved access and quality mental health care for children," said APA Medical Director Steven M. Mirin, M.D., in a press release. "That the Congressional Children's Caucus is addressing this issue is a positive step."
Presiding at the hearing were the caucus chair, Representative Sheila Jackson Lee (D-Tex.), and vice chair, Representative Ileana Ros-Lehtinen (R-Fla.).
"We want to allow the voices of children and those who know the most about their situations to be heard," said Lee in the press release. "Our goal is to gain greater understanding of the problem and to begin to formulate solutions."
The Congresswomen heard testimony from representatives of federal and private mental health groups, including the Substance Abuse and Mental Health Services Administration (SAMHSA), the American Foundation for Suicide Prevention, and the Mental Health America, as well as family members.
Lee's legislative assistant, Jennifer Leach, told Psychiatric News that Lee plans to introduce legislation to improve children's mental health coverage and work with advocacy groups including APA to achieve that goal.
SAMHSA Administrator Nelba Chavez, Ph.D., testified before the caucus about the scope of mental health problems in children and the federal response.
"About 20 percent of our children and youth have a diagnosable mental disorder. Five to 9 percent of youth have such a serious emotional disturbance that it limits their capacity to function appropriately at home, school, or in their communities."
SAMHSA believes that the best approach to prevention and early intervention is establishing a continuum of services and engaging family members in the treatment process, Chavez stated. A case in point is SAMHSA's Comprehensive Community Mental Health Services for Children and Their Families Program.
Preliminary findings based on the first two years of program activity across multiple sites show that "increased service intensity for the most severely impaired children does appear to pay off," said Chavez. "Children in the program no longer experience five to 12 placements a year and are receiving the support they need to remain in their communities and families."
The Starting Early Starting Smart (SESS) program was initiated by SAMHSA to ensure safe and appropriate long-term foster care and support services. Since 1996 more than 1,300 children and youth in 23 communities across 13 states have received services.
SESS integrates mental health and substance abuse prevention and treatment services into primary health care and early childhood settings for high-risk young children and their families. The goal is to increase access to these services and thereby improve outcomes. Twelve programs and a data collection center have received SAMHSA awards to evaluate the effectiveness of this approach.
The impact of managed care systems on youth with serious emotional disturbances and their families has also been evaluated by SAMHSA, according to Chavez.
Preliminary findings show that children in managed care programs are less likely to receive specialty mental health services compared with children who are in other types of health care settings and have similar levels of dysfunction and disorder. The parents of youth who have serious emotional disturbances and are treated in managed care settings appear to have limited knowledge of the types of providers, payment sources, and content of mental health services provided to their children.
Progress has been made in identifying and treating depression and ADHD in children and adolescents, according to Peter Jensen, M.D., associate director of child and adolescent research and chief of the Developmental and Psychopathology Research Branch of the National Institute of Mental Health.
He referred to a recently completed NIMH-funded study indicating that fluoxetine (Prozac) is more effective than placebo in treating major depression in this population. Because of these and other findings, the pharmaceutical industry has recently greatly expanded its efforts to determine the safety and efficacy of the newer antidepressant agents, added Jensen.
Research has also shown that many core clinical symptoms of ADHD respond well in the short term to stimulant medication such as Ritalin. However, a two-year multisite multimodal treatment study is being conducted on children with ADHD to compare the effectiveness of medication to psychosocial treatments and combined medication and psychosocial treatments. The preliminary results will be reported later this spring, said Jensen. NIMH is also working with the U.S. Department of Education to disseminate the results.
"Through this and other partnerships, we hope to mainstream the nation's mental health research agenda for children," said Jensen.
Underrecognition of depression and other mental health problems by primary care providers and preschool teachers, however, remains a concern. "The results of such inattention may be far more costly for society later as these children grow older."
Michael Faenza, president and chief executive officer of the Mental Health America, testified before the caucus that the majority of children and adolescents in the nation's juvenile justice system have serious mental and emotional disorders that remain untreated.
He noted that the U.S. Department of Justice is threatening lawsuits in two states, Louisiana and Georgia, for violating the civil rights of children in the juvenile justice system by failing to meet their mental health treatment needs.
For example, the Department of Justice reported that in Georgia mental illness is addressed mainly through discipline, isolation, and restraints.
Faenza also criticized the "get tough" approach to juvenile justice advocated in the Violent and Repeat Offender Act of 1997, which Congress will revisit this year.
Faenza urged Congress to take the following steps to help children rather than lock them up:
"If we are able to provide mental health treatment and services, it is likely that children in the juvenile justice system will become law-abiding citizens and make valuable contributions to society," concluded Faenza.