Street roots., August 16, 2013, Page 7, Image 7

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Street roots
Aug. 16, 2013
f
1
1
Kids
these
days
The U S. Surgeon General's
office says that only 20 percent
o f emotionally disturbed
children receive help while the
American Medical Association
estimates there are only 7,000
psychiatrists available for some
15 million children requiring
treatment
BY NOELLE SWAN
S T R E E T N E W S S E R V IC E
don’t know exactly what happened to
drive that young man in Aurora to shoot
those people, but I do know that many
people like him suffer while undiagnosed
and untreated,” said Jess Shatkin, an
associate professor of child and adolescent
psychiatry at New York University.
July 20, marked one year since James
Eagan Holmes massacred 12 people and
injured 70 more inside an Aurora, Colorado
movie theater. Since then, Adam Lanza
opened fire in a Newtown, Connecticut
elementary school; a 20-year-old college
student killed four people in Orange County,
California during a drive-by shooting; and a
19-year-old in New Orleans opened fire on a
Mother’s Day parade.
In each of these tragedies, images of
isolated and despondent young male
perpetrators have emerged in the
aftermath. And after each tragedy, the
nation vowed to launch a national discussion
on mental health.
In fact, millions of young people in
America are suffering from untreated
mental illness and the health care system is
not equipped to care for them, according to
experts in child and adolescent psychiatry.
The U.S. Surgeon General’s office estimates
that only 20 percent of emotionally
disturbed children receive mental health
services.
Those children do not automatically shed
their emotional problems on their 18th
birthday. They become adults with mental
illness. Some find treatment as adults; some
turn to drugs and alcohol to manage their
symptoms; and some lose control.
The American Medical Association
estimates that there are 15 million
American children in need of psychiatric
care and just 7,000 child and adolescent
psychiatrists to treat them.
This discrepancy can leave families
waiting months for their children see a
therapist, which can take a toll on individual
families and the community, said
Christopher Thomas, the director of child
psychiatry residency training at the
University of Texas, Galveston.
Untreated adolescents who struggle with
emotional problems can fall behind in
school, develop substance abuse problems
and engage in dangerous and risky behavior,
Thomas said.
“Well over 80 percent of youth in juvenile
justice placement have a substance abuse
problem. More than half likely have a
mental disorder,” Thomas said. Sadly, the
I
STREET R O O TS P H O T O
juvenile justice system is becoming the de
While the number of untreated children
facto mental health provider for a large
varies around the country, the AACAP has
number of these youths.”
found a shortage of providers in every state.
Thomas has spent over a decade studying
Even Massachusetts, which has the
the shortage and distribution of child and
highest per-capita ratio of child and
adolescent
adolescent
psychiatrists in the
psychiatrists, falls
U.S. His 1999 paper
short of meeting the
in the Journal of the
need in many
American Association "W e a l l s ta r te d w it h th e b e s t
communities, says
of Child and
Stuart Goldman,
in t e n t io n s , b u t I t b e c o m e s
senior associate in
Adolescent
w
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d
i
f
f
i
c
u
l
t
to
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tic
e
psychiatry and
Psychiatrists
co-director of the
(AACAP) spurred the p s y c h ia t r y th e w a y y e a k n o w
Mood Disorder
AACAP to launch a
y o n s h o u ld p r a c tic e
Program at Boston
task force on
p s y c h ia t r y w h e n y o n a re so
Children’s Hospital.
workforce issues,
c r a m m e d w it h p a t ie n t s . "
That shortage is
which aims to recruit
JESS SHATKIN compounded by an
medical students into
A S S O C I A T E P R O F E S S O R O F C H IL D A N D
A D O L E S C E N T P S Y C H IA T R Y A T N E W Y O R K
unequal distribution
the specialty.
U N IV E R S IT Y .
along socioeconomic
Both Shatkin, the
lines, with the
current chair of the
majority of child and
AACAP Workforce
adolescent
Issues Committee,
psychiatrists
and Thomas said that
practicing in affluent communities, Goldman
recruiting new students into the field
said.
continues to be an uphill battle more than a
While many wealthy neighborhoods of
decade later.
Boston have an abundance of private
The specialty requires an additional two
practice and outpatient hospital physicians,
years of training beyond the three years of
areas like South Boston, Dorchester, and
general psychiatry studies. The extra time
Roxbury do not have many local providers.
and student loans discourage potential
“One of the issues (exacerbating the
students, Shatkin says.
problem) is that kids who are living in
“The best we can hope for is staying
poverty have higher rates of mental health
pretty much in the situation that we are
problem,” said Goldman. “Just the problem
already in, but I fear that we might actually
of being poor is a challenge, but they also
be falling further behind,” Thomas said.
live in communities with lower property
Meanwhile, children around the country
taxes and lower housing costs, which
wait months for the necessary care.
My Closet
By Paula Ramirez
In my closet are shoes and clothes
Maybe a few skeletons of stories
Untold.
In my closet there’s no one
Scared to be free.
Stand up proud
For all the world to see.
In my closet there’s no judgment or hate.
In my heart, there’s no difference
Between gay or straight.
typically translate to poorer schools and
fewer community services.”
These disparities persist throughout the
country. The communities most in need
tend to have the least access to mental
health services. The problem becomes self-
perpetuating.
Many doctors who start out in a clinic
setting quickly become overwhelmed by the
heavy caseload, Shatkin says.
As part of his residency training, Shatkin
worked in an Arkansas clinic where he says
he routinely saw 15 patients a day, 10 new
patients a week, and still had a six-month
waiting list.
In medical school, child and adolescent
psychiatrists are taught to take time to get
to know patients and to reach out to the
various caregivers in their lives to learn how
they function in the real world, Shatkin said.
“We all started with the best intentions,
but it becomes very difficult to practice
psychiatry the way you know you should
practice psychiatry when you are so
crammed with patients,” he explained.
In the end, many practitioners opt to
leave the clinic setting. Instead they open
up private practices where patients can
afford to pay service-based fees.
“Everybody gets sick and needs care, so
it’s not like you’re doing the wrong thing
treating these people. They need help, too,
and they are able to pay for the time. To be
honest, treating people when you have the
time is a delight,” Shatkin said.
That is of little comfort to the low-income
families struggling to cope with their
children’s emotional issues. The current
economic climate has deepened the
problem, as it has placed added strain on
both family budgets and social services.
Thirty years ago, community mental
health centers provided local counseling
services to residents in their own
neighborhoods, Goldman recalls. “Many
dried up in the 1990s and more dried up in
the economic downturn of the last five
years,” he said.
“While we want to be a society that
protects and cares for the least fortunate ...
in tough budget times, the services for
indigent care and for child care suffer,”
Goldman said.
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