How many children in need of mental health care do not receive it?

In 2003, two of five U.S. children and adolescents (41%) who needed treatment for an emotional, developmental, or behavioral problem did not receive mental health care or counseling during the past year. Unmet need for care was greater among young children (62%) and those without insurance (66%).

Why is this important?

One of five children and adolescents experiences mental health problems severe enough to need evaluation in a given year (Kataoka et al. 2002), and one of 10 suffers from a mental illness that causes impairment. Medication and psychosocial therapies are efficacious for treating many mental disorders in children and adolescents (DHHS 1999).

Research suggests that one-half of all mental disorders experienced throughout the lifetime begin by age 14 (Kessler et al. 2005). Identifying children at risk of developing psychosocial problems arising from factors such as parental depression, maltreatment, or other family dysfunction is important, because early intervention may prevent lifelong problems (DHHS 1999).

The Surgeon's General's Conference on Children's Mental Health concluded that "mental health is a critical component of children's learning and general health. Fostering social and emotional health in children as a part of healthy child development must therefore be a national priority" (PHS 2000).

Findings

In 2003, among community-dwelling children and adolescents (ages 1–17) with emotional, developmental, or behavioral problems that needed treatment or counseling (according to a parent), only three of five (59%) received any mental health care or counseling in the past year.

• Receipt of needed care was lower young children ages 1–5 (39%) than among middle children and adolescents (59% to 64%), and among uninsured children (34%) than those with either public (59%) or private (63%) coverage.
• The rate of mental health services varied by 20 percentage points between the states in which children were most likely (Wyoming 77%) and least likely (Delaware 57%) to received needed mental health care (CAHMI 2005).

Implications

Two million U.S. children and adolescents have an unmet need for mental health services as perceived by their parents. Young children may be less likely to receive needed mental health care because parents consider the signs and symptoms associated with their mental health problems to be less severe than those manifested in older children. The social consequences of unmet need include lost opportunities to prevent suicide, poor academic performance, substance abuse, and future unemployment (DHHS 1999).

Improvement Ideas and Resources

The 2000 Surgeon's General's Conference on Children's Mental Health set several goals for national action, including promoting public awareness of children's mental health issues, improving the assessment and recognition of mental health needs in children, and training frontline providers to recognize and manage mental health care issues.

• The American Academy of Pediatrics is collaborating with the federal Maternal and Child Health Bureau on an IMPACT program "to improve children's mental health by offering pediatricians and other primary care professionals the tools and support they need to provide community-based, collaborative care."
• The Commonwealth Fund–sponsored Assuring Better Child Health and Development (ABCD) program offers a model of collaborative learning emphasizing the use of standardized screening tools to identify young Medicaid-enrolled children in need of services that will support healthy mental development (Kaye 2006).
• Other approaches being used by states to improve access to mental health services for children enrolled in Medicaid and State Children's Health Insurance Programs include integration of services, coordination of care, and performance-based contracting (May 2006).

Measure:

The denominator includes community-dwelling children and adolescents ages 1–17 whose parent responded YES to the following question: "Does [CHILD'S NAME] have any kind of emotional, developmental, or behavioral problem for which he/she needs treatment or counseling?" The numerator includes the subset of the denominator population whose parent responded YES to the following question: "During the past 12 months, did [CHILD'S NAME] receive any mental health care or counseling?" (CAHMI 2005).

Limitations:

It is not known to what degree parents' perceptions of their children's need for mental health care is informed by professional versus personal judgment (probably some degree of both). Because parents may not recognize some symptoms of mental illness in their children, these data likely underestimate the unmet need for mental health care. For comparison, a previous national study found that 79 percent of children and adolescents with a clinical need for mental health care (as assessed by researchers based on parent-reported child behaviors) did not receive any mental health services in the past year (Kataoka et al. 2002).

Source:

Data were compiled by the Child and Adolescent Health Measurement Initiative using the 2003 National Survey of Children's Health, a nationally representative, random-digit-dialing telephone survey of households with one or more children under 18 years old. Survey respondents are parents or guardians who know the most about a randomly selected child's health and health care (CAHMI 2005).

References:

* Indicates source of data used in the chart(s).

* CAHMI (Child and Adolescent Health Measurement Initiative). 2005. National Survey of Children's Health, 2003. Data Resource Center for Child and Adolescent Health. Portland: Oregon Health & Science University.

DHHS (Department of Health and Human Services). 1999. Mental Health: A Report of the Surgeon General. Rockville, Md.: National Institute of Mental Health, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.

Kataoka, S. H., L. Zhang, and K. B. Wells. 2002. Unmet Need for Mental Health Care Among U.S. Children: Variation by Ethnicity and Insurance Status. American Journal of Psychiatry 159 (9): 1548–55.

Kaye, N. 2006. Improving the Delivery of Health Care That Supports Young Children’s Healthy Mental Development: Early Accomplishments and Lessons Learned from a Five-State Consortium. Portland, Maine: National Academy for State Health Policy and The Commonwealth Fund.

Kessler, R. C., P. Berglund, O. Demler et al. 2005. Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62 (6): 593–602.

May, J. 2006. Strategies for Improving Access to Mental Health Services in SCHIP Programs: Issue Brief. Vol. Portland, Maine: National Academy for State Health Policy.

PHS (U.S. Public Health Service). 2000. Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda. Washington, D.C.: U.S. Department of Health and Human Services.