Most US Children With Mental Illness Go Untreated

Fran Lowry

May 07, 2015

More than 17 million children in the United States have or have had a diagnosable mental illness, yet most are not treated, according to the first annual Children's Mental Health Report released by the Child Mind Institute (CMI) in New York City.

The fact that so many children are struggling with these debilitating and serious disorders without competent psychiatric care represents a very serious public health problem, Child Mind Institute President Harold Koplewicz, MD, told Medscape Medical News.

"In the US, 7 million kids under the age of 18 have asthma, 7 million have peanut allergy, and 200,000 under the age of 20 have diabetes. But 17.1 million children under the age of 18 have or have had a diagnosable psychiatric illness, so the common disorders of childhood and adolescence are mental illness. It's not mumps, measles, rubella, not asthma, it's certainly not peanut allergy," Dr Koplewicz said.

"What is most troubling is that less than 35% of these kids ever get help. So it's not a surprise that 70% of kids in the juvenile justice system have a diagnosable psychiatric illness, and we are not just talking about symptoms, which affect 50% of the population under 18. If we are talking about serious debilitating illness, it's 22% of the population. This is absolutely, truly, a public health crisis," he said.

The full report is online at www.childmind.org/speakup.

Interactive Report

"It is an interactive report that gives the statistics on prevalence, on need vs treatment, on how few kids get treated, statistics on shortages with providers, on suicide attempts and rates, and on treatment efficacy, among other things," Dr Koplewicz said.

Dr Harold Koplewicz

"The nice thing about it is that you can easily see our sourcing. You just have to put your mouse over the source field and you get every article that we used. The report has taken the most credible and controlled studies available, and we have vetted it with every scientist featured," he said.

Among the report's highlights:

  • 80% of children with anxiety disorder are not getting treatment;

  • 40% of children with diagnosable attention-deficit/hyperactivity deficit disorder are not getting treatment;

  • 60% of kids with diagnosable depression are not getting treatment;

  • 70.4% of youth in juvenile justice settings meet criteria for a psychiatric diagnosis.

"Eighty percent of the kids who have anxiety disorder do not get help. This is tragic. Anxiety disorders are serious. They prime the brain for depression in your teen years, and depression during adolescence puts you at a 50% higher risk of having depression as an adult. We're not talking about demoralization, we are talking about real, debilitating illness," Dr Koplewicz said.

The Child Mind Institute's Children's Mental Health Report also highlights the effective treatments that are available, the importance of early intervention, and the costs of not recognizing and addressing childhood mental illness.

"It is estimated that the cost of lost productivity and crime spending related to mental illness in Americans under age 24 is a staggering $202 billion," Dr Koplewicz said.

"But the cost of human suffering does not have a price. There aren't enough providers, enough access, and the suicide rate among young people 14 to 24 stays remarkably high. We're going to lose close to 5000 young people to suicide. More children will die from suicide than from asthma, cardiac disease, AIDS, diabetes, and peanut allergy combined. Every physician and, in particular, pediatricians should care about this," he said.

Dr Koplewicz added that the Child Mind Institute is the only nonprofit organization in the United States that is exclusively dedicated to getting a better understanding of the developing brain and how to treat children with mental illness and learning disabilities.

"Our aim is similar to St. Jude's 50 years ago and the way they battled childhood cancer," he said.

Of special note to parents is the fact that the Child Mind Institute has no affiliation with the pharmaceutical industry. In fact, pharmaceutical representatives are not allowed on the institute's grounds.

"We do not take money from the pharmaceutical industry. I think we might be the only medical institution that has taken that stand. We even put it in our charter. So if I tell you that medicine is an option to treat children, parents should feel comfortable, because I'm not doing it because I'm being paid to do so, I'm doing it because it's medically sound," Dr Koplewicz said.

For many psychiatric illnesses, therapy is just as effective as medication but will take longer to work.

"This is important for parents who are reluctant to have their kids take medication. For instance, giving medicine alone is almost as effective as giving the combination of psychotherapy and medication for anxiety disorder. Psychotherapy alone doesn't work as quickly, but if you wait 36 weeks, studies show that everyone gets an 80% return.

"So this means, as a parent, you can make a decision not to use meds and instead wait it out for the psychotherapy to take effect. While you are waiting, your child may not go to school and continue to be symptomatic, but Child Mind is giving you the data that over time, if you stick with the psychotherapy, it will work as well as the combination or the medicine alone," Dr Koplewicz said.

More information for parents can be found at http://www.childmind.org/en/parents-guide-getting-good-care/.

A National Priority

"I think it is wonderful that CMI is bringing attention to this important topic," David C. Rettew, MD, a child and adolescent psychiatrist at the University of Vermont, in Burlington, told Medscape Medical News.

Dr David Rettew

"The amount of suffering that children are enduring due to emotional-behavioral problems is enormous, and it is about time that we make this a national priority. The fact that much of this could be avoided with proper assessment and intervention makes these facts even more of a tragedy," Dr Rettew said.

"It is also worth pointing out, especially to critics of mental health treatment, that we are not looking to use medications as a quick fix to these problems. It has been well established that many kinds of psychotherapy can be very effective for these diagnoses, as are a number of wellness and health promotion strategies," he said.

"Also, to those who would like to say that we are overdiagnosing everything, I would point out that if we conducted a national survey of kids and asked them how many of them were ever diagnosed with an orthopedic or respiratory problem, we'd probably get numbers even higher, yet nobody accuses these folks of making things up. Why must we continue to have a double standard in mental health?"

Dr Koplewicz and Dr Rettew report no relevant financial relationships.

Child Mind Institute. Children's Mental Health Report. Full text

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