Addressing the shortage in child mental health care
Even in this wealthy state, very sick children and their families daily discover treatment is available only if they are willing to drive hours to weekly appointments. Some families even confront the worst scenario of all – that there simply isn’t any timely treatment available.
If such a dearth of treatment were for physical ailments such as asthma, diabetes or even cancer, it’s unlikely it would be tolerated by the public or lawmakers. The shortage is in the field of mental health, however, where stigma, misunderstanding and a shortage of strong advocates has long contributed to the challenges associated with ensuring appropriate and adequate care.
It has long been a fact that a dire scarcity of child and adolescent psychiatrists in the country regularly leaves the most vulnerable children and their families in no-win situations. They endure without treatment, wait intolerably long periods before obtaining treatment or regularly careen from one inpatient crisis — such as a suicide attempt resulting in hospitalization — to the next. The shortage has persisted despite at least one intense recruitment campaign by the American Academy of Child and Adolescent Psychiatry.
Thankfully, there now is a beacon of hope for these suffering children and their families. A provision of the recently enacted 21st Century Cures Act, adopted with rare bipartisan congressional support and signed by President Obama earlier this month, seeks to increase the number of pediatric and adolescent psychiatrists by providing a financial incentive for medical students to spend the extra time and money necessary to be trained to practice in the subspecialty.
The incentive not only is important and necessary, it’s long overdue.
According to information from the American Academy of Childhood and Adolescent Psychiatry, in the vast majority of U.S. states, there are fewer than 17 practicing pediatric psychiatrists per 100,000 children age 17 or younger. Connecticut is one of just nine states where the shortage is not quite as severe, but it is still categorized as high, which by the academy’s standards means having somewhere between 18 and 46 practicing pediatric psychiatrists per 100,000 children.
A closer look at the academy’s map of the state shows most of these specialists practice in or around New Haven, in connection with Yale University. In eastern Connecticut, the situation is much worse. Both New London and Tolland counties have a severe shortage of these professionals and Windham County, the state’s poorest, actually has no such professionals.
In addition to the overall shortage, the average age of these doctors is 52. “This fact alone makes the need to build the pediatric psychiatrist workforce pipeline a vital goal now, so that children in the state are not even more underserved in the future,” said Rep. Joe Courtney, who supported the bill.
A prime reason so few young people train for this subspecialty is that it requires five or six years of study and training beyond medical school. In addition to the time, that additional study is expensive, yet pediatric psychiatrists earn far less than some other medical specialists. From a purely financial perspective, it is not a good investment.
A program run by the National Health Service Corps, which is overseen by the U.S. Department of Health and Human Services, has long offered help in paying off loans to various medical specialties, everything from dental hygienists to mental health nurse practitioners are on the list. That incentive will now extend to those training to be pediatric psychiatrists, allowing for up to a $50,000 loan repayment if a person agrees to serve in a high-need area, including in remote regions or locations with high poverty rates.
The need is clear and urgent. The Substance Abuse and Mental Health Services Administration reports in 2014 more than 2.7 million children suffered a major depressive episode. According to the Centers for Disease Control and Prevention, more than 400 children under age 14 committed suicide that same year.
These children’s suffering should not be ignored or prolonged. The incentive in the 21st Century Cures Act is a sensible step toward attracting more professionals to this specialty. We commend the lawmakers who supported this important legislation and hope it is just the first step of many toward alleviating the shortage of child and adolescent psychiatrists.
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