Hold On, It's Not Over

A Blog about Children's Mental Health in Massachusetts

My top stories on children’s mental health in 2010 — what are yours?

We are all looking forward to 2011, making our resolutions and hoping, as we always do, for a better year. The end of the year is also the time when we look back before we look forward. There were many events in 2010 which will impact all of us who parent children with mental health needs or work with them and their families. Here are my picks for the top stories. What are yours?

#1. The health care reform law passed and began to offer protections for consumers across the country and the promise of coverage to the uninsured. The passage of the Affordable Care Act was signed into law by President Obama in March and some portions of the new law are already in effect including that young adults can remain on their parents’ insurance plans. The law requires mental health to be covered and people cannot be turned away or dropped from coverage because of pre-existing conditions. Although Massachusetts has had health care reform since 2006, many families have insurance that is solely regulated by federal law and this will change things for the better for them.

#2. Federal mental health parity was an under-the-radar story which will also have a major impact. The new federal mental health parity law, enacted in 2008, went into effect in 2010. For the first time, mental illness must be treated by insurance companies in the same way as other chronic conditions, like diabetes and hypertension. Parity is incredibly important to those affected by mental health condiditons, yet it was not widely noted while health care reform was debated. Again, while Massachusetts has had a mental health parity law, many families will only see changes under federal parity.

#3. Following an outbreak of LGBT teen suicides across the country , columnist Dan Savage launched the “It Gets Better” campaign in September, which lets gay teens know that if they hang in there, life will improve after high school. It’s a brilliant campaign and thousands of people (both celebrities and regular people) have posted personal stories on YouTube in an effort to offer hope to countless LGBT youth worldwide and shine a spotlight on the harm caused by bullies. LGBT youth are up to four times more likely to attempt suicide than their heterosexual peers according to the 2006 Massachusetts youth risk survey.

#4. The bullying and subsequent suicide of Phoebe Prince in January went from a local tragedy to an international media storm about bullying in schools. The tragedy of her death came just months after the suicide of 11-year-old Carl Walker-Hoover of Springfield and galvanized advocates, lawmakers and the media to advocate for change. In April, the Massachusetts Legislature passed a new law mandating that every school system in the Commonwealth come up with a plan by the end of the year for dealing with bullying issues.

#5. Another local event which captured national media attention was the trial and conviction of Rebecca Riley‘s mother (in January) and father (in September). Rebecca Riley was found dead on the floor of her home in 2006 from the combined effects of Clonidine, Depakote and other medications. Each of her parents was found guilty of murder. Many national and local reporters wrote and narrated stories that doubted the existence of mental health issues in very young children as well as the use of medication. Unsurprisingly, a complicated situation was pared down to a discussion of mental health, medication and young children.

#6. One of the most important stories of 2010 never got media coverage. The first full year of the implementation of Children’s Behavioral Health Intiative, although imperfect, continues to provide Massachusetts families with home and community based services on a previously unheard of scale. Nearly 70% of children and teens are receiving behavioral health screens at well-child visits, and almost 6500 children and youth have received care coordination with nearly 19,000 experiencing at least one of the new remedy services. Families report that they feel they are considered a partner in their child’s treatment and are particularly satisfied with the services provided by a family partner. What is striking is that while other states have created similar services, none has done it on such a scale. CBHI is available across the state to children with signicant mental health needs on MassHealth.

#7. In October, the Boston Globe reported that many children are deemed "too acute" by some hospitals when asked to consider an admission. Children and teens who are violent, hallucinate or have complicated psychiatric histories are most likely to be turned away. Just last week I heard a story of a teen waiting in an emergency room after being turned away from hospitals in Massaachusetts and two other states. Sounds like a story we’ll hear more of in 2011.

These are my top stories. Did I miss any or are there any that should not have made the list?

January 1, 2011 Posted by | children's mental health | , , , , , , , , , , , , , , , , , , , , , , , | 2 Comments

Diagnosing very young children

Last week Rebecca Riley’s mother went on trial, accused of deliberately overdosing her 4 year old daughter.  Although most of the media coverage has so far been focused on the facts, I keep waiting for the other shoe to drop.  What might also end up on trial is the practice of diagnosing and treating young children.  

As little as 10 to 15 years ago the public found it difficult to believe that elementary and middle school children could experience depression or be diagnosed with mental health disorders.  Childhood is supposed to be a time of happiness, right?  The combination of increased media coverage, targeted studies and consequent data have helped increase public acceptance that children can and do experience depression, anxiety and mood disorders as well as ADHD.  However, the public doesn’t really accept that young children can have mental health problems and has no idea what that looks like if they do.

Eight years ago PAL and Health Care for All issued a report, Speak Out for Access.  We surveyed families whose children had identified mental health needs about their experiences.  We were surprised to find that almost half (48%) of the parents who responded said that their child showed signs of mental health problems by age 4.  Let me say that again:  almost half the parents said their child with mental health needs showed signs or symptoms by age 4.  When they brought their worries to their child’s doctor, many felt their observations were dismissed.  Some felt that earlier treatment would have reduced many of the problems they faced later.

This is a topic that is near and dear to me.  When my own son was three, he had a bedtime ritual that lasted 20 to 25 minutes.  It involved an empty spray bottle and a series of spots we had to spray to banish monsters.  If we missed a spot or were interrupted, the ritual had to begin again from the beginning.  He cried and was terrified if we skipped the ritual and then couldn’t fall asleep — often for hours.  His pediatrician assured me he would grow out of it.  He did, but other fears and rituals immediately took its place.

Last Friday, a journal article authored by Mark Olfson of Columbia University, reported that the number of children aged 2 to 5 who have been diagnosed with bipolar disorder and treated with psychiatric medications has doubled over the past decade.  The study also noted that fewer than half the preschoolers had received a mental health assessment or a therapy visit, which is worrisome but unsurprising.  After all, where do you go to find help for a 3 year old?

There is a difference between prevalence (how often something is diagnosed) and incidence (how often something actually occurs), although we confuse the two.  According to the journal report, young children are being diagnosed more frequently.  According to parents in our report, a large percentage of children, later diagnosed with mental health disorders, show symptoms quite early. 

Parents want to help their children, especially when they see them hurting.  They spot the intensity or unusual length (like my son’s ritual) of a behavior.  A diagnosis often feels like a double edged sword;  it can open doors to treatment and services but brings the stigma of a label.

January 25, 2010 Posted by | children's mental health, Uncategorized | , , , , | 2 Comments