When 80 percent do not receive care

By Michael Douglas
Beacon Journal editorial page editor

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Not long into a conversation with Elaine Harlin and Dr. Steven Jewell, the numbers surface. The president of Child Guidance & Family Solutions and its medical director note that one in five children ages 9 to 17 suffer from a diagnosable mental illness that causes at least some impairment of their daily activities.

Of that one in five, they add, just 20 percent receive treatment, or a fraction of a fraction. So one challenge becomes how to bring care to the remaining 80 percent.

Doing so certainly promises to be worthwhile. Children who receive proper evaluation and treatment can lead productive lives, pursuing their dreams in school, work and family life. Broaden the reach of care, and you start to address a disheartening toll.

Suicide ranks as the third leading cause of death among young people from ages 15 to 24. The National Alliance on Mental Illness points out that more teens and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, flu and chronic lung disease combined.

More than 90 percent of children and adolescents who commit suicide suffer from a mental illness.

Roughly half of students age 14 and older with a mental illness drop out of high school.

And 50 percent of all lifetime cases of mental illness begin by age 14. So there is an imperative to intervene early and repair lives.

Fifteen minutes rarely pass without a public figure of some kind professing his or her concern for children, for the opportunities they deserve, for the future they share. Yet the reimbursement rate for mental health services under Medicaid hasn’t changed in 14 years, still at $90 per hour.

That puts a heavy financial strain on organizations such as Child Guidance & Family Solutions. As Elaine Harlin explains, participation in the public health-care program involves reporting requirements, meeting standards for performance, implementing best practices and other steps. More, the agency must keep pace in developing and training its staff. None of these items has decreased in cost the past decade.

Harlin makes a reasonable case for a higher reimbursement rate. What she and others face is talk about curbing entitlement spending, or Medicaid reducing the amount it reimburses.

Know that Judge Linda Teodosio of the Summit County Juvenile Court has seen the benefits of treatment. It has reduced dramatically the number of young people sent to the state Department of Youth Services, making less likely a life of crime, reflecting the finding that every dollar invested in treating mental illness yields $7 in return.

Part of the challenge isn’t so much about resources as it is devising better ways to identify those children who need treatment. Dr. Jewell sees promise in developing deeper partnerships with pediatric practices. Pediatricians would be in position to make an initial assessment and then reach out to a specialist, perhaps even one with a presence in their offices.

That may help to address two limiting factors. One is the stigma that, unfortunately, still attaches to mental illness. Families may find it easier to make an appointment with their pediatrician.

The other barrier is the shortage of child psychiatrists, just 8,000 or so across the country. The shortage stems, in part, from a hiccup in federal support of graduate medical training, for four years, not the five needed for child psychiatry. There also is the complexity of the job. Children change markedly from 5 years old to 15. Parents are part of the equation, invaluable to care, yet bringing another dimension.

Add the element of poverty, and the work can get more difficult.

Akron Children’s Hospital has a training relationship with the Northeast Ohio Medical University. What seems plain enough is that screening for mental illness in children differs from testing for diabetes or asthma. And if a community or state is going to make substantial gains in identifying children in need of mental health care, it eventually will require more child psychiatrists, counselors and others crucial to the quality of treatment.

So it does come down to resources, say, that reimbursement rate. Summit County benefits from the levy money available through the Alcohol, Drug Addiction and Mental Health Board. The Medicaid expansion will help.

Yet the country hardly spends too little on health care. An essential objective of reform is slowing the increase in the current $2.2 trillion a year. So it becomes a matter of priorities, on which items are our dollars best spent.

Those parents with children suffering from mental illness know the helplessness, the fear and uncertainty, the dread when the phone rings. Many also know the joy when treatment restores their child.

For its part, the larger public should bear in mind what advocates often stress: No illness afflicts so many children, and if left untreated brings so much harm, from childhood into adulthood.

Douglas is the Beacon Journal editorial page editor. He can be reached at 330-996-3514, or emailed at mdouglas@thebeaconjournal.com.

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