Mental health services for children lacking in many high-income countries


By Linda Carroll

(Reuters Health) - One in eight children have mental health disorders requiring treatment, but even in high-income countries most of these children will not have access to services, a new systematic review and metanalysis suggests.

Researchers examined data on more than 61,000 children from 14 studies done in 11 countries and published between 2003 and 2020. Overall, prevalence of mental health disorders was 12.7%, and among children with mental health disorders, 55.8% received no services, according to the results published in the Journal of Evidence-Based Mental Health.

The result "is much avoidable suffering for these young people, and for their families, when mental disorders therefore then persist, untreated," said study coauthor Dr. Charlotte Waddell, university professor and director of the Children's Health Policy Centre in the Faculty of Health Sciences at Simon Frazer University in Vancouver, Canada. "There is also much avoidable long-term disability as a result."

"Collectively, we are all affected by the resulting lost human potential," Dr. Waddell said in an email. "Collectively, as well, we are all diminished by not attending to children's rights to receive effective healthcare when they need it. So, we need to do better, and we can."

The reasons for failure to adequately take care of children's mental health may vary from nation to nation, Dr. Waddell said.

"But looking at Canada as an example, here children's services are made to compete, if you will, with adult healthcare services. In particular, much healthcare spending is allocated to seniors," she added.

"There is also an issue with some mental health concerns being less obvious, or more hidden, than physical health concerns," Dr. Waddell said. "For example, often a child's anxiety or depressive symptoms may be 'invisible' to many people in their lives. In contrast, if a child has a broken bone or an infection or diabetes or cancer, we understand that quickly and we do what it takes to provide the care they need. But for mental health, we often do not either notice or provide the care."

To take a closer look at the burden of mental health disorders in children and whether these disorders are being treated, the researchers analyzed pooled data from 14 studies described in 249 articles; eight of the 14 studies included data on service use.

Four of the studies were done in the U.S., and one each was conducted in: Australia, Canada, Chile, Denmark, Great Britain, Israel, Lithuania, Norway, South Korea, and Taiwan.

Eleven of 14 studies used DSM-IV or DSM-IV-TR diagnostic standards, two used ICD-10 and one used DSM-5. Most studies reported diagnoses using assessments of symptoms and impairment over one-year periods.

The most common diagnoses were anxiety (5.2%), followed by attention-deficit/hyperactivity (3.7%), oppositional defiant (3.3%), substance use (2.3%), conduct (1.3%) and depressive (1.3%) disorders. Among children with mental health disorders, only 44.2% received any services for these conditions.

Advocacy may help, Dr. Waddell said.

"Practitioners, for example, can do this," she said. "Speaking as a child and adolescent psychiatrist, I see the damage done when young people cannot get effective services and get these services promptly. So, I advocate, as many practitioners do. Writing this article was a form of advocating. But the bottom line is that we need to significantly increase public funding for children's mental health, and we need to make sure these budgets are protected and dedicated."

"These impressive findings highlight the scale of unmet need for child and adolescent mental health services even in high-income nations," said Dr. Mark Olfson, the Dr. Elizabeth K. Dollard professor of Psychiatry, Medicine and Law at the Columbia Irving Medical Center in New York City, and a professor of epidemiology at the Columbia University Mailman School of Public Health.

"Building the necessary specialized mental health workforce to address this challenge will be a slow process," Dr. Olfson, who was not involved in the new research, said in an email. " In the meantime, opportunities exist for supporting primary care practitioners to help them care for children with less complex mental health needs, educating parents and caregivers about risks and common warning signs, motivating them to seek out appropriate mental health care for their children, and combatting stigma that so often impedes efforts to pursue mental health care for young people."

SOURCE: Evidence-Based Mental Health, online July 19, 2021.

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