sign in sign up
<<
Home , Pediatrics

Meeting the Demand for Pediatric Mental David Axelson, MD

Poor access to and adolescent increased by 86% from 2007 to 2017.2 psychiatrists has long been a concern Recent data indicate that there has raised by pediatricians, , and been an increase in the prevalence of other stakeholders. Wait times for new pediatric mental health diagnoses, appointments can be many months, and including depression, attention-deficit/ families may be required to travel long hyperactivity disorder, bipolar disorder, distances. In the article “The Growth and spectrum disorders.3,4 and Distribution of Child Psychiatrists Access to care is clearly a concern. in the United States: 2007–2016” in Pediatric visits this issue of Pediatrics, McBain et al1 for mental health conditions have risen evaluate whether we have made any steadily.5 A recent report found that progress in expanding the child 16.5% of (7.7 million) in the workforce, both in number United States have an identifiable and distribution. They found that from mental health condition.6 However, 2007 to 2016, the number of child only 49% of them were receiving Department of Psychiatry and Behavioral Health, Nationwide Children’s and College of , The psychiatrists increased by 21%, and the treatment from any mental health Ohio State University, Columbus, Ohio number of children in the United States professional, let alone a psychiatrist. Opinions expressed in these commentaries are declined slightly. The United States now those of the author and not necessarily those of the has 9.75 child psychiatrists per 100 000 This leads to the question: how many American Academy of Pediatrics or its Committees. child psychiatrists do we need? The children aged 0 to 19. However, they DOI: https://doi.org/10.1542/peds.2019-2646 found an eightfold variation in American Academy of Child and Accepted for publication Sep 12, 2019 prevalence per 100 000 children among Adolescent Psychiatry estimates that states, ranging from a low of 3.3 in 47 child psychiatrists per 100 000 Address correspondence to David Axelson, MD, children would be sufficient, which is Department of Psychiatry and Behavioral Health, Idaho to a high of 26.5 in Nationwide Children’s Hospital, 700 Children’sDr, Massachusetts. Child psychiatrists are quadruple the rate found by McBain Columbus, OH 43205. E-mail: david.axelson@ 1,7 still concentrated in metropolitan et al. The recently published Health nationwidechildrens.org areas; 70% of counties do not have one. Resources and Services Administration PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, (HRSA) “Behavioral Health Workforce 1098-4275). – ” There are challenges in evaluating how Projections, 2016 2030 made the Copyright © 2019 by the American Academy of much the increase addresses the unsubstantiated determination that at Pediatrics shortage. As the authors note, they most, the demand for child psychiatric FINANCIAL DISCLOSURE: Dr Axelson receives counted the number of practicing services in 2016 exceeded the supply royalties from Wolters Kluwer UpToDate. 8 psychiatrists but did not determine by 20%. Using this evaluation of FUNDING: No external funding. how much of their time was devoted to current shortage, the HRSA projected POTENTIAL CONFLICT OF INTEREST: The author has clinical practice with children. The an oversupply of 3720 child indicated he has no potential conflicts of interest to authors also could not examine changes psychiatrists in 2030. This flawed disclose. in the prevalence or severity of analysis illustrates the importance of COMPANION PAPER: A companion to this article can 1 pediatric mental illness. Unfortunately, the McBain et al data. The HRSA be found online at www.pediatrics.org/cgi/doi/10. there is evidence that the burden of estimated an annual rate of increase in 1542/peds.2019-1576. mental illness in youth has significantly child psychiatrists that was double increased over the past decade. In the (4.28% vs 2.17%) what was found by To cite: Axelson D. Meeting the Demand for United States, the rate of death by McBain et al.1 There is no reason to Pediatric Mental Health Care. Pediatrics. 2019; suicide in children aged 10 to 19 expect such a rapid increase. 144(6):e20192646

Downloaded from www.aappublications.org/news by guest on September 27, 2021 PEDIATRICS Volume 144, number 6, December 2019:e20192646 COMMENTARY Assuming that the child psychiatrist the team. The psychiatrist can also 2007 to 2016. Pediatrics. 2019;144(6): shortage is closer to what American consult to and school e20191576 Academy of Child and Adolescent settings while using 2. CDC. Fatal injury data. Available at: Psychiatry estimates, the current rate capabilities to extend care to https://www.cdc.gov/injury/wisqars/ of increase will not meet the need for underserved areas and improve the fatal.html. Accessed August 11, 2019 child psychiatric services over the quality and efficiency of consultation. 3. Mojtabai R, Olfson M, Han B. National next decade. There have been To effectively implement this kind of trends in the prevalence and treatment a number of proposals to expand the model, child psychiatry training will of depression in adolescents and young child psychiatry workforce that have need to emphasize communication, adults. Pediatrics. 2016;138(6): merit, including making child administrative, leadership, and e20161878 psychiatrists eligible for federal loan consultation capabilities. repayment programs, offering a 4- Reimbursement strategies must be 4. Perou R, Bitsko RH, Blumberg SJ, et al; Centers for Disease Control and year child psychiatry as an adjusted, and many psychiatrists will Prevention (CDC). Mental health alternative to the traditional 5-year need to be willing to perform more surveillance among children–United postgraduate training, and improving team-based and consultative care States, 2005-2011. MMWR Suppl. 2013; coding rules and reimbursement to instead of exclusively working with 62(2):1–35 compensate for the additional time patients on an individual basis. and complexity that accompanies 5. Mapelli E, Black T, Doan Q. Trends in Investment in developing better pediatric emergency department working with children. systems of care with thoughtful utilization for mental health-related Another way to address the shortage integration of child psychiatrists is visits. J Pediatr. 2015;167(4):905–910 more likely to lead to the best is to more effectively use the limited 6. Whitney DG, Peterson MD. US national child psychiatry workforce: how can outcomes for our children rather than and state-level prevalence of mental child psychiatrists make the greatest focusing only on increasing the health disorders and disparities of impact for the most children? This number of psychiatrists. We need to mental health care use in children. population health approach requires start making this investment and be JAMA Pediatr. 2019;173(4):389–391 a reconceptualization of the child open to change and innovation to 7. AACAP. Workforce maps by state: psychiatrist’s role, particularly in improve our children’s mental health. practicing child and adolescent ambulatory settings. The child psychiatrists. 2018. Available at: https:// psychiatrist serves as a leader for www.aacap.org/AACAP/Advocacy/ multidisciplinary teams that may ABBREVIATION Federal_and_State_Initiatives/ include advanced practice providers, HRSA: Health Resources and Serv- Workforce_Maps/Home.aspx. Accessed psychologists, nurses, therapists, and August 11, 2019 ices Administration other mental health professionals. 8. HRSA. Behavioral health workforce The psychiatrist evaluates and treats projections, 2016-2030: psychiatrists the subset of patients who truly need (adult), child and adolescent REFERENCES psychiatric expertise and works with psychiatrists. 2018. Available at: https:// administrative leadership to devise 1. McBain R, Kofner A, Stein B, et al. The bhw.hrsa.gov/sites/default/files/bhw/ the best system of care while serving growth and distribution of child nchwa/projections/psychiatrists-2018. as a consultant to guide members of psychiatrists in the United States from pdf. Accessed August 2, 2019

Downloaded from www.aappublications.org/news by guest on September 27, 2021 2 AXELSON Meeting the Demand for Pediatric Mental Health Care David Axelson Pediatrics 2019;144; DOI: 10.1542/peds.2019-2646 originally published online November 4, 2019;

Updated Information & including high resolution figures, can be found at: Services http://pediatrics.aappublications.org/content/144/6/e20192646 References This article cites 5 articles, 2 of which you can access for free at: http://pediatrics.aappublications.org/content/144/6/e20192646#BIBL Collections This article, along with others on similar topics, appears in the following collection(s): Psychiatry/Psychology http://www.aappublications.org/cgi/collection/psychiatry_psycholog y_sub http://www.aappublications.org/cgi/collection/public_health_sub Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.aappublications.org/site/misc/Permissions.xhtml Reprints Information about ordering reprints can be found online: http://www.aappublications.org/site/misc/reprints.xhtml

Downloaded from www.aappublications.org/news by guest on September 27, 2021 Meeting the Demand for Pediatric Mental Health Care David Axelson Pediatrics 2019;144; DOI: 10.1542/peds.2019-2646 originally published online November 4, 2019;

The online version of this article, along with updated information and services, is located on the World Wide Web at: http://pediatrics.aappublications.org/content/144/6/e20192646

Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. Pediatrics is owned, published, and trademarked by the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2019 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

Downloaded from www.aappublications.org/news by guest on September 27, 2021