Over the past two years, increasing attention has been given to the mental health crisis that exists in the United States. It is surprising to many, even in health care, that 1 in 5 children suffers from a diagnosable mental health disorder during their childhood, according to the National Alliance on Mental Illness (NAMI). Even more shocking is that suicide is now the third-leading cause of death among young people between the ages of 10 and 24.
Early identification and treatment of mental illness are key to helping children live up to their potential. Half of all adults with persistent mental illness first experienced symptoms before the age of 14, according to NAMI, but many waited more than 10 years for a diagnosis and treatment.
Waiting a significant amount of time for treatment can significantly decrease positive outcomes and increase costs. In addition, pediatric patients with mental health problems and chronic illnesses have much higher medical care expenditures than children with one or the other.
That’s why CHOC Children’s in Orange County, Calif., and other providers in our area have been working together to improve the system of care for children diagnosed with mental health conditions.
The Foundation of Improved Care
One cornerstone of early identification of mental health problems is for pediatricians and family medicine physicians to screen children for behavioral health conditions, and I’m pleased to report this approach is becoming standard in Orange County. Through grant funding, the managed Medicaid system in Orange County offers physicians an incentive to screen all children at their 12-year well-child visits. Locally, medical practices—regardless of payer—have started screening children for depression at their 11- or 12- year well-child visits.
CHOC conducts universal screening with the PHQ-9-A, a nine-item depression-screening scale. We also screen for suicidal ideation among all patients older than 11 who present to the hospital’s emergency department (ED) for any reason. We find that more than 10 percent of children presenting for medical reasons have been at risk of suicide.
These screenings allow for the earlier identification of children with mental health diagnoses and the opportunity to connect these children to early mental health treatment. Ideally, treatment should start while children’s brains are still developing. By embedding this screening into routine medical care, we also may reduce stigma about mental health treatment.
CHOC is also addressing the challenge of engaging families in care. The mental health system is fragmented, and specialized services for children—especially younger children—can be difficult to find. Traditionally, mental health services are provided by referrals to clinicians whom families do not know, and researchers have documented that fewer than half of families attend an appointment made via referral.
To overcome these challenges, CHOC is locating mental health providers in pediatricians’ offices, the ED, and inpatient units, where warm handoffs can occur. While this approach can be helpful, insurance benefit plans often thwart these handoffs by prohibiting a mental health visit on the same day as a medical visit. For these cases, CHOC is using a care management approach—following up with families to help them overcome the barriers to accessing mental health treatment for their children, just as we do for children with chronic medical conditions.
We are increasingly understanding the effects of mental health issues on physical health, including shortened life spans and increased healthcare costs. It is time for health professionals in leadership roles to recognize there is no physical health without mental health.
This approach requires increasing the integration of mental health screening and services into the care of pediatric patients. This increased integration, in turn, requires additional training—and advocacy to eliminate financial barriers.
Most of all, it requires thinking outside of the box, but a younger generation is depending on us to do so. We at CHOC join with others in the movement to acknowledge that #HealthisHealth. The outcomes for today’s children will be better for our attention to this issue.
Heather Huszti, PhD, is chief psychologist, CHOC Children’s, Orange County, Calif.