Thursday, July 08, 2004

More On Children's Mental Health
Support the Child Healthcare Crisis Relief Act

Yesterday, I posted a critique of the widespread practice of placing children with mental illness in detention centers, without adequate treatment.  This is just one consequence of a broad problem facing our country.  Not only is there a nationwide shortage of pediatricians, but there is an even greater shortage of psychiatrists who have specialized in treating children and adolescents (1  2). 

Regarding pediatricians, the Children's National Health Center report (linked previously) states:

A survey of more than 400 pediatricians located across the United States found that access to quality care for American children is the greatest concern facing pediatricians. The survey found that a large majority of pediatricians agree that time constraints on patient treatment is diminishing the quality of pediatric care in this country.

Importantly, pediatricians believe that this issue affects American children at all socioeconomic levels, in every part of the country. Access, which translates into time with pediatricians, is not just a problem for the disenfranchised and uninsured, but for all families.

They described a system that is seriously dysfunctional and about to fail under its own constraints. Many indicate that they are willing to be involved in defining changes needed to improve or reform the health care system. These pediatricians report that too many children are falling below the acceptable level of care.

Regarding child and adolescent psychiatrists, Psychiatric Times states:

Many children with mental health problems are either not being seen, or are being seen by professionals who have not been trained in the principles of development and childhood psychopathology, said Thomas F. Anders, M.D. He told Psychiatric Times, "We believe that the care that many of these kids are getting today is inadequate." [...]

The U.S. Bureau of Health Professions projects that at current recruitment levels, the nation will have only two-thirds of child and adolescent psychiatrists needed to meet the demand by 2020--8,312 child psychiatrists versus a need for 12,624.

A "severe maldistribution" of practicing child psychiatrists further exacerbates the problem. While Massachusetts has 17.5 child and adolescent psychiatrists per 100,000 youths, West Virginia has only 1.3, and the national average is 7.5.

These problems are known to have a serious negative impact on our country, even if expressed solely in monetary terms.  From the National Mental Health Information Center:

The annual prevalence figures translate into millions of adults and children disabled by mental illness. The disability toll can be quantified in a way that cannot be ignored: when compared with all other diseases (such as cancer and heart disease), mental illness ranks first in terms of causing disability in the United States, Canada, and Western Europe, according to a study by the World Health Organization (WHO, 2001). This groundbreaking study found that mental illness (including depression, bipolar disorder, and schizophrenia) accounts for 25% of all disability across major industrialized countries (Figure 1). In the US, the economy's loss of productivity from mental illness amounts to $63 billion annually (DHHS, 1999).

OK, there is a problem.  What is being done about it?  From the site, Caught on Film  (A chronology of Bush saying one thing then doing another), here is President Bush's stance on children's hospitals:

Bush Event

Bush Rhetoric



Children’s Hospitals


Bush touts the need to support children’s hospital at Egleston Children’s Hospital in Atlanta [3/1/01]



“This is a hospital, but it's also - it's a place full of love.  And I was most touched by meeting the parents and the kids and the nurses and the docs, all of whom are working hard to save lives.  I want to thank the moms who are here.  Thank you very much for you hospitality…There's a lot of talk about budgets right now, and I'm here to talk about the budget.  My job as the President is to submit a budget to the Congress and to set priorities, and one of the priorities that we've talked about is making sure the health care systems are funded.” – Egleston Children's Hospital, Atlanta, Georgia 3/1/01  



Bush’s first budget proposed cutting grants to children’s hospitals like the one he visited by 15% ($34 million). His 2004 budget additionally proposes to cut 30% ($86 million) out of grants to children’s hospitals.


From a NAMI website:

Plan Doesn't Address Gap in Community Services, Drops Important Support Programs

Washington D.C. February 19--President George W. Bush's federal budget plan for fiscal year 2003, released February 4, falls extremely short of the need in terms of mental health spending. Although the President has committed his Administration to implement the Supreme Court's Olmstead order to end unnecessary institutionalization, his $2-trillion budget plan (available at: http://www.whitehouse.gov/omb/budget/) fails to address the growing gap in community-based services for adults and children with serious mental disorders.

From a Howard Dean website, we see the following statistics pertaining the the State of Texas under governor Bush:
  • 48th in per capita funding for public health

  • 47th in delivery of social services

  • #1 in percentage of poor working parents without insurance

  • #1 in children without health insurance

In health care policy, there is a concept known as "parity."  In this context, parity refers to the practice of mandating that health insurance companies provide the same level of coverage for mental illnesses that they provide for somatic illnesses.  from one of Senator Kerry's websites:

Despite Promises to Support Mental Health Parity, Bush Lets GOP Leaders Kill Wellstone Mental Health Equitable Act. President Bush announced his qualified support for the Senator Wellstone Mental Health Equitable Act in April 2002, but only for “serious” mental illness which he chose not to define. The legislation has been blocked by Republican Speaker of the House Denny Hastert, who believes it would cost businesses too much to cover mental illness. When Senate Democrats tried to bring the bill up for a vote on October 25, 2003, the one year anniversary of Senator Wellstone’s death, Republican Senate Majority Leader Bill Frist refused to allow the bill to be considered. [National Journal, 5/4/02; Roll Call, 3/17/03; Star Tribune, 10/24/03]

To be fair, we cannot necessarily blame President Bush for everything that happens in the Senate, but clearly, if he had wanted to be true to his word, he could have had a positive influence in the situation described above.  More blameworthy is Senator Frist.  He's a physician, yet he doesn't seem to be concerned about health care.

From another portion  of Kerry's site:


At an April 2003 meeting of the Commission on Human Rights in Geneva, the United States stood alone in opposing a resolution urging countries to commit to realizing the universal right to the highest attainable standards of physical and mental health. The resolution calls on countries to enhance their efforts to eliminate discrimination in health care, prevent violence, promote sexual and reproductive health, take steps to protect the fundamental right to health for their own citizens, and assist developing countries in achieving higher standards of health. Among the 43 countries voting, the United States was the only one to vote against the resolution.

Senator Kerry has issued a statement  regarding his mental health policy:

[...] I believe we must make progress on mental illness and end this discrimination and stigma for once and for all. As President, here’s where I would start.

First, we have to make sure we require full mental health parity once and for all. Not just mental health parity for certain benefits or certain mental health conditions or with unnecessary loopholes that allow insurers to skirt their responsibility. We also need parity in our public programs. That’s why I have fought for mental health parity in the Medicare program – closing differences in cost-sharing for mental health benefits.

Second, let’s strengthen the Medicaid program. States are starving under the Bush economic policies and are forced to cut back on Medicaid as well as community mental health services. I will protect the Medicaid program. That means stopping the Bush so called "reform," which would essentially block grant the Medicaid program and threaten benefits and coverage. I have also proposed $25 billion a year in state relief for the next two years that would help protect the program.

Third, we not only need to strengthen Medicare and Medicaid we need to reform them. It makes no sense that the Medicaid program prevents people from working and receiving health care at the same time. We made some progress with the Jeffords-Kennedy legislation enabling people to receive Medicaid and work but it is three years later and we still have not passed the Family Opportunity Act. We need to pass it right away. And even that legislation does not fix all of the skewed incentives. Why does the Medicaid program often cover institutional care and not community-based care? That makes no sense.

I’ve worked to ensure that people with mental illness who are on the welfare rolls receive the services they need to get and stay employed. [...]

From Independents for Kerry:

Guaranteed Health Care for Every Child
Studies show that kids without health insurance are less likely to get checkups or treatment for ear infections or asthma. Kids without health care also have a harder time learning in school. In a new compact with the states, the Federal government will pick up the cost of Medicaid coverage for children in exchange for automatic enrollment of all school children eligible for the Children's Health Insurance Program. Eligibility for coverage will be extended to 300 percent of poverty-level incomes for children, and coverage will be extended to the six million single and childless adults who are uninsured and live below the poverty line. Independent experts estimate that the Kerry plan will cover 99 percent of America’s children.

Is there anything you can do?  Yes.  There is legislation pending that would help alleviate the shortage of child and adolescent psychiatrists.  The American Academy of Child and Adolescent Psychiatry has a website that makes it easy to send letters to your Senators and your US Representative.  Go to the site, and enter your zip code; this takes you to the page that enables you to send messages to congress, urging support for the Child Healthcare Crisis Relief Act, H.R. 1359. 

Oh, and remember to vote for Kerry.

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