Cover Story

Gaps in mental health training pose imminent crisis for pediatric care

According to the National Institute of Mental Health, approximately 13% of children aged 8 to 15 years in the United States will experience a severe mental disorder at some point in their lives. Most mental health conditions develop by the age of 24, with 50% of lifetime cases of disorders emerging by the age of 14 in the form of autism, attention-deficit/hyperactivity disorder, anxiety, behavioral problems and depression. Left untreated, severe mental health conditions can lead some children to take their own lives; suicide remains the third leading cause of death among youth aged 10 to 24, with a higher mortality rate than AIDS, cancer, heart disease, birth defects, stroke, pneumonia, influenza and chronic lung disease — combined.

Despite these disturbing statistics, in a 2013 survey conducted by the AAP, 65% of pediatricians believed they lacked the necessary training in the treatment of children with mental health problems, 40% responded they lacked the ability to diagnose mental health problems and more than 50% reported they lacked confidence in their ability to treat these patients.

Photo courtesy of Keith Weller/Johns Hopkins Medicine

Julia A. McMillan, MD, FAAP, professor emerita of pediatrics at Johns Hopkins School of Medicine, emphasized that a lack of training has left primary care providers with inadequate knowledge to identify children with mental health needs.

More than ever, pediatricians and other primary care providers are finding themselves on the front line of child mental health care, whether screening for autism, initiating medications for ADHD or depression, or providing counsel for parents of children with behavioral problems. Where once there was an opportunity to outsource mental health problems, national shortages of pediatric medical specialists have returned responsibility to individual providers; further compounding this problem is that current pediatric residency training requirements no longer necessitate curricular elements or assessment requirements in mental health.

“A vicious circle exists where the service demands of residency programs and the hospitals that fund them do not give residents the experience and the teaching that they need,” Julia A. McMillan, MD, FAAP, professor emerita of of pediatrics and the pediatric residency program at Johns Hopkins School of Medicine. “Those pediatric residents become faculty for the subsequent generation of pediatric residents who also do not receive the training and the experience that they need.”

Inadequate training leaves primary care providers unprepared to identify children with mental health needs, which can further delay referral to an already depleted workforce of early intervention providers. Even once a referral is made, a child suspected of having mental health conditions can spend months on a waiting list for evaluation from a subspecialist.