A Child & Adolescent Psychiatrist’s Perspective

CHILDREN’S MENTAL HEALTH CARE IN GA

Sarah Y. Vinson, MDTriple Board Certified Child & Adolescent, Adult and Forensic PsychiatristVP/President Elect of the GA Council on Child & Adolescent Psychiatry

CHILD & ADOLESCENT MENTAL ILLNESS AND TX

• 13% of youth aged 8-15 and 21% of youth aged 13-18 live with mental illness severe enough to cause significant impairment in their day-to-day lives. 1

• There are average delays of 8-10 years between the onset of symptoms and intervention. 2

• In the U.S. nearly 80% of youth with mental illness do not receive treatment. 3

1. National Health and Nutrition Examination Survey2. NIMH 20053. Mental Health: A Report of the Surgeon General

National Alliance on Mental Illness, Accessed Nov. 2015 at NAMI.ORG

PER CAPITA M.H. SPENDING BY STATE

CHILD PSYCHIATRY SHORTAGE• According to a study by Kelleher et al, psychosocial problems are “the most common

chronic condition for pediatric visits, eclipsing asthma and heart disease.”

• An April 2009 Health Affairs study reported that pediatricians were more likely than other primary care physicians to be unable to refer their patients to outpatient mental health services.

• In Georgia, the shortage is compounded by the fact that there are only SIX graduating child psychiatrists per year.

• With only 5.9 child psychiatrists per 100,000 youth, Georgia falls below the U.S. national average rate.

• Apart from the raw numbers, one must also consider that the majority of child psychiatrists do not devote all of their clinical hours to child and adolescent psychiatry, rather they see a mixture of adult and child and adolescent patients.

• No major hospital system champion

• Interfacing with a broken, decentralized under-funded child mental health safety net system

• Few salaried outpatient mental health opportunities focusing on children

• No increased reimbursement for added complexity of treating children/adolescents and families

• Low show rates and no manner to recoup costs in private practices serving children with Medicaid

• Shifting formularies with CMOs

GA C & A PSYCHIATRISTS’ WORK ENVIRONMENT

PSYCHOSOCIAL DETERMINANTS OF M.H.• Childhood Trauma

• Adverse features of housing and neighborhoods

• Food Insecurity

• Housing Insecurity

• Poverty

PTSD

Traumatic Exposure

Intrusion NM, play, memories,

dissociation, emotional or physiologic

responses to triggers

Avoidance of..Thoughts,

feelings, external reminders

Negative Changes in MoodTrauma related emotions

Diminished interest in activities

Feeling alienatedConstricted affect

Negative changes in thoughtsInability to recall features of

the eventPersistent negative beliefs

about self and worldDistorted blame of self and

others

Alterations in in Arousal and reactivity

Irritability, aggression, self-destructive or reckless bx,

hyper vigilance, low concentration, sleep

problems

70%Of the children in the juvenile justice system have a mental health disorder and approximately 20% have a serious mental illness

1. Joseph J. Cocozza and Kathleen R. Skowyra, “Youth with Mental Health Disorders: Issues and Emerging Responses,” Juvenile Justice, 7 (April 2000): 6; available at www.ncmhjj.com/pdfs/publications/Youth_with_Mental_Health_Disorders.pdf.

POSSIBLE AREAS FOR INTERVENTION• Governing with psychosocial determinants of mental health in mind

• Programs supporting parental mental health

• Incentives for Evidence-Based therapeutic approaches such as TF-CBT

• Support of/Collaboration with Child Psychiatry Training Programs

• School-based services that are available to the most vulnerable populations

• Increasing access to mental health care in primary care settings

• Funding structures that provide financial sustainability for mental health consultation and collaboration with primary care physicians

• State and/or Private Insurance Funded Phone Consultation Lines