Abstract
Recently I had the honor of speaking at a meeting of Vice-President Biden's Commission on Gun Violence in Washington, DC, attended by an amazing group of mental health professionals and chaired by HHS Secretary Sibelius and Attorney General Holder. The only good thing to come out of the events at Sandy Hook was a new resolve to talk about why it happened.
At the meeting we agreed that America desperately needs a national conversation about mental health—particularly child and adolescent mental health. Silence on this issue is a contributing factor not only to this violence but to a more pervasive tragedy that is affecting our kids: the marginalization of young people struggling with psychiatric disorders. Stigma, misinformation, and lack of access to care have created a public health crisis that in rare instances erupts in deadly violence towards others. More frequently it results in kids not reaching their potential, dropping out of school, developing alcohol and substance abuse problems—and hurting themselves.
President Obama mentioned this national conversation in his announcement of executive orders aimed at curbing gun violence, and he brought up the issue again in his second inaugural address. We eagerly await what the leadership of the White House will bring in this critical area. In the meantime, I believe it would behoove us as professionals to consider this public health problem in anticipation of helping the country—and the world—overcome it. There are three main reasons this problem exists:
• Shame and stigma keep families from seeking help early on;
• Institutional barriers limit access to mental health care;
• Research into developing innovative, evidence-based treatments is lacking.
We know that most parents do not seek help as soon as symptoms appear. Stigma and misinformation keep families from acting even when their children exhibit alarming behaviors. If they do get help, they still may not have the full support of their community due to persistent misconceptions about mental illness. The bottom line is this: our culture simply does not treat disorders that occur from the neck up with the same respect, compassion, and scientific rigor as disorders that occur in any other part of the body. And we will not be able to change that until we are able to destigmatize these disorders affecting millions of children and adolescents.
Access to care is also a problem. There are just 7,500 practicing child and adolescent psychiatrists in the United States—far fewer than are required to meet the need. Moreover, those who are practicing in these disciplines are often forced to limit patients to cursory 15-minute visits and are reimbursed only for the "medication part" of the treatment, not the more time-consuming behavioral treatments and psychosocial interventions that could be highly effective. Many families lack health insurance, and those who are insured find that coverage for psychiatric disorders is so limited that insurance may only pay a fraction of the cost of the services.
Finally, there are not enough innovative treatments available. We have not seen a truly new, original drug for childhood psychiatric disorders since Prozac was released in the 1980s. And we also have not seen widespread acceptance of psychosocial innovation in the way that intervention is delivered, even when evidence-based treatments are available. Of course, this Journal is an example of how we can change that.
In his December 16 remarks in Newtown, President Obama asked: "Can we say that we're truly doing enough to give all the children of this country the chance they deserve to live out their lives in happiness and with purpose?" As long as we fail to address the mental health needs of children and adolescents, the answer is no. While mass shootings are rare, the pain of untreated psychiatric disorders is common and the social cost is steep.
Now is the time to address the systemic failures that leave so many of our young people without help. As my colleagues I am sure you understand this, and I trust that all of us will dedicate our knowledge and resources to this task.