September, 2006

“The burden of suffering by children with mental health needs and their families has created a health crisis in this country. Growing numbers of children are suffering needlessly because their emotional, behavioral and developmental needs are not being met by the very institutions and systems that were created to take care of them.” (Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda, January 2001)

Prevalence and Consequences of Youth Mental Illness

• According to the National Center for Health Statistics, in 2005, 16% of U.S. children aged 4-17 had parents who had talked to a health care provider or school personnel about their child’s emotional or behavioral difficulties during the past 12 months.
• Without intervention, child and adolescent disorders frequently continue into adulthood. For example, research shows that when children with co-existing depression and conduct disorders become adults, they tend to use more health care services and have higher health care costs than other adults. If the system does not appropriately screen and treat them early, these childhood disorders may persist and lead to a downward spiral of school failure, poor employment opportunities, and poverty in adulthood. No other illnesses damage so many children so seriously (The President’s New Freedom Commission on Mental Health, Final Report, July 2003).
• In its 2000 report, the Coalition for Juvenile Justice estimated that 50 – 75% of teenagers in the juvenile justice system have a diagnosable mental disorder and these numbers appear to be growing.
• While the need is up and the rates of use are increasing, the sobering fact remains that only about 20% of you with emotional and behavioral needs are receiving mental health care. The lack of trained providers in children’s mental health contributes to these problems of access and availability (Transforming the Workforce in Children’s Mental Health, Nat’l Technical Assistance Center for Children’s Mental Health, Georgetown University, 2004).

Shortage of all Children’s Mental Health Professionals:

• There is a dearth of child psychiatrists, appropriately trained clinical child psychologists, and social workers. Furthermore, many barriers remain that prevent children, teenagers, and their parents from seeking help from the small number of specially trained professionals who are available...This places a burden on pediatricians, family physicians, and other gatekeepers to identify children for referral and treatment decisions. ?n(Mental Health: A Report of the Surgeon General, 1999).
• Although the supply of well-trained mental health professionals is inadequate in most areas of the country, rural areas are especially hard hit. In addition, particular shortages exist for mental health providers who serve children, adolescents, and older Americans (Achieving the Promise: Transforming Mental Health Care in America, The President’s New Freedom Commission on Mental Health, Final Report, July 2003).
• Provider shortages have been documented in private practice, community clinics, public hospitals and public mental health care systems that seek to keep severely disturbed children at home with programs such as respite care, day treatment, and therapeutic foster care (The Provider System for Children’s Mental Health: Workforce Capacity and Effective Treatment, Nat’l Health Policy Forum, Oct., 2004).

Marketplace/Health Care System Demand for Child and Adolescent Psychiatrists:

• Of all the children they see, primary care physicians identify about 19% with behavioral and emotional disorders. While these providers frequently refer children for mental health treatment, significant barriers exist to referral, including lack of available specialists, insurance restrictions, appointments delays, and stigma (The President’s New Freedom Commission on Mental Health, Final Report, July 2003).
• Increased use of specialty mental health professionals was not accompanied by a substantial increase in supply…..Many communities now report lack of availability of child psychiatrists and of inpatient hospital beds for crisis care of children (Trends and Issues in Child and Adolescent Mental Health, Health Affairs, September/October 2003).

Shortage of Child and Adolescent Psychiatrists:

• In the entire United States, there are approximately 7,000 child and adolescent psychiatrists. Child and adolescent psychiatry is the only board certified medical specialty that trains physicians to treat the mental disorders of children and adolescents. Only 300 child and adolescent psychiatrists complete training each year.
• There is a severe maldistribution of child psychiatric services in the U.S., with children in rural areas and areas of low SES having significantly reduced access. The ratio of child and adolescent psychiatrists per 100,000 youth ranges from 1.3 in West Virginia to 17.5 in Massachusetts with an average of 7.5 (Kim et al., 2003).
• In 1990, an Abt Assoc. report updated the 1980 GMENAC report. The report, prepared for the Council on Graduate Medical Education (COGME), a committee of the Dept. of Health and Human Services, concluded that by 1990, the U.S. should have over 30,000 child and adolescent psychiatrists.
• In 2000, the Bureau of Health Professions projected that between 1995 and 2020, the use of child and adolescent psychiatrists will increase by 100%, with general psychiatry’s increase at 19%.
• The number of child and adolescent psychiatry residents has not increased in the past decade; 712 in 1990, and 709, 723, 742 in 2003-5. The number of child and adolescent psychiatry training programs has decreased by 5 to 114 in the same period (ACGME, 2006).
• The proportion of IMG’s in child and adolescent psychiatry residency programs has substantially increased from about 20 percent in 1990 to 46 percent (AMA, 2005) because of declining interest by USMG’s.

Recruitment/Funding Problems:

• Graduate Medical Education (GME) funding limits child and adolescent training support to only a portion of the full residency, although geriatric psychiatry is fully supported. Extending GME funding through child and adolescent psychiatry training would provide a strong incentive to choose this shortage specialty.
• The Balanced Budget Act (BBA) of 1997 reduced direct GME funding by 50 percent for subspecialty training beyond the primary specialty board eligibility. This is an additional cut to child and adolescent psychiatry that had not received indirect GME funding in the past.
• The 1997 BBA provided incentives to teaching hospitals for reduction of GME positions. It also resulted in the severe reduction of Medicare reimbursement to teaching hospitals. The reductions in the health care services and health professions training grants in 2001 have affected, and the state and federal budgetary problems will further affect negatively teaching hospitals, the GME programs, and especially child and adolescent psychiatry residency programs.

Prepared by the American Academy of Child and Adolescent Psychiatry Contact: Kristin Kroeger Ptakowski, Deputy Executive Director and Director of Government Affairs and Clinical Practice,
202-966-7300 ext. 108, mailto:kkroeger@aacap.org