The treatment of mental conditions must start early
Kurt Newman, a pediatric surgeon, is president and chief executive of Children’s National Medical Center.
Since becoming chief executive of Children’s National Medical Center, I have spent a great deal of time thinking about the larger issues that affect children’s health and their ability to reach their full potential in adulthood. For me, no issue is more critical than ensuring both healthy bodies and healthy minds.
We must change our thinking and our approach to ensuring mental health for children. I propose beginning with the following steps:
1. Accept that mental health is a children’s health issue. One in five children in the United States suffers a medical condition that affects their mental health. These encompass a wide range of diagnoses, including depression, anxiety, eating disorders and developmental disorders. Of the 15 million children affected by such conditions, only 20 percent ever receive treatment. This is especially sobering when we consider that by age 14, half of all lifetime diagnoses of mental illness will begin manifesting, and that 75 percent will show up by age 24. In the face of these numbers, children and families urgently need better ways to get necessary support.
2. Start screening early. As with obesity and diabetes, pediatricians know that, by detecting disease in childhood and intervening early, we can have a tremendous effect on the health of that person in adulthood. By contrast, there is an average delay of eight to 10 years between the onset of symptoms and treatment for children with mental health issues. This is driven in part by a lack of focus on early identification. For the one in five children who has a mental health condition, such early recognition could be lifesaving.
3. Treat the child, not the diagnosis. A diagnosis is, at best, a start, not an end. This is especially true in mental health. Children with the same diagnosis can exhibit profoundly different behaviors and need very different approaches. To be effective, the treatment of mental health in children must be individualized for the child and his or her family, and it must include an understanding of environmental, social and developmental factors.
4. Address genetics. As with several forms of cancer or metabolic diseases, many mental health conditions have a significant genetic predisposition. Technological breakthroughs the past few years — in molecular evaluation, genetic sequencing and variation, biomarkers and advanced imaging — have helped us understand, identify and intervene in many medical issues before they manifest symptoms. It is time to use these tools as much for mental health as we do for cancer and other diseases with a high genetic predisposition.
5. Ensure access to medical care. Even with the most advanced approaches, real change cannot be achieved if the significant shortages in pediatric mental health providers are not addressed. This is a profound failing in a health system that is supposed to ensure children receive the best care.
Now is the time for leadership. As we form task forces, forums and expert panels to respond to the shootings in Newtown, Conn., a discussion must take place about how we ensure the mental health and well-being of our children. If it does not, we will have failed both the children who perished Dec. 14 and those we are fortunate enough to still have in our care