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Children’s Mental Health Treatment Is Lacking, Even in High Income Countries

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Key Takeaways

  • Despite the high rates of mental health issues in children around the world, many of them don't get the help or treatment they need.
  • Less of half of the children polled in a recent multi-nation study received treatment for their mental health disorder.
  • A lot more effort on screening and prevention is needed to help children recover from mental health issues, say experts.

Millions of children around the world have mental health concerns, from mood disorders like anxiety and depression to behavioral disorders like attention deficit hyperactivity disorder (ADHD). 

Undiagnosed or untreated mental health issues can have devastating consequences, including chronic pain, incarceration, and suicide. But children simply aren’t getting the help they need to improve their mental health—and thus improve their prospects and overall quality of life. 

According to a large study comparing the prevalence of children with mental health concerns and the rate at which they get treatment, less than half of the children polled who had a mental health disorder had received treatment. The research, published in the journal Evidence-Based Mental Health, found that one in eight children have mental health problems that cause symptoms and impairment and therefore require treatment, but most of them—even those in high-income countries—don’t get access to the necessary services. 

A Closer Look at the Study 

The researchers, from the Children’s Health Policy Centre team, analyzed data from 14 studies in 11 countries, including the U.S., the U.K., Australia, and Canada, published between 2003 and 2020. The studies included a total of 61,545 children aged 18 years or younger.

The team found that the overall prevalence of childhood mental disorder was 12.7%, and the most common mental disorders were anxiety (5.2%), attention-deficit/hyperactivity disorder (ADHD) (3.7%), oppositional defiant disorder (e.g., argumentative behavior) (3.3%), substance use disorder (e.g., problematic use of alcohol or cannabis) (2.3%), conduct disorder (1.3%), and depression (1.3%).

Aron Janssen, MD

This study tells us that kids are struggling and are in need of a lot more care that we have available, and that we need a lot more effort in screening and prevention.

— Aron Janssen, MD

In her job as a child and adolescent psychiatrist, lead author Charlotte Waddell, MD, from the Faculty of Health Sciences at Simon Fraser University, Vancouver, has seen many examples of young people with mental health problems who didn’t get help early enough. Even so, she was surprised by the low levels of service reach. “We thought that it would be better,” she reveals. “But this is galvanizing us to get the word out.”

What’s most frustrating to the researchers is that effective treatments are well known for all of the most common childhood mental disorders, as are effective prevention programs for the majority of them. “We know how to help,” Dr. Waddell says. “But we simply are not putting enough public resources into children’s mental health.” 

“This study tells us that kids are struggling and are in need of a lot more care that we have available, and that we need a lot more effort in screening and prevention,” says psychiatrist Aron Janssen, MD, who is a Verywell Family Review board member.

Children’s Mental Health Should Be a Priority 

Dr. Waddell notes that mental disorders typically begin in childhood and adolescence and if they are not prevented or treated early, they significantly interfere with well-being and development—with the impact often extending across a lifetime. 

“Mental health service provision also lags behind services available to treat physical conditions in most of these countries,” she adds, pointing out that nobody would find it acceptable to treat only 44% of children who had cancer or diabetes or infectious diseases, for example.

“People need to appreciate that these disorders are real, and are causing real problems for young people and their families,” Dr. Waddell says. 

She believes there are several reasons for the low level of mental health reach for children. For starters, mental health problems are often invisible, unless they have happened to you or your child or your family member. “Young people with these problems can look ‘normal,’ unlike when a child has a broken leg or a bad infection,” Dr. Waddell explains. 

Amy Morin, LCSW

Kids who are struggling with a mental health issue, like depression and anxiety, may report physical symptoms such as headaches or stomach aches.

— Amy Morin, LCSW

Another reason is the shame and stigma attached to mental health problems. “We do not blame people for their physical health problems, but for mental health, sometimes we do,” Dr. Waddell says. 

Dr. Janssen agrees that stigma is an issue. “Folks don’t want to talk about mental illness, which makes it really tough to seek out care,” he says. He adds that money is a major factor, because reimbursement rates for mental health care pale in comparison to medical care, and reimbursement rates for pediatric medical care pale in comparison to adult care.

“As such, it’s nearly impossible to break even if you want to see kids with insurance and Medicaid,” he explains. “If insurance companies valued the time of mental health care providers in the same way as the valued the time of anesthesiologists, you’d have folks on every corner.” 

For real change to happen, children and people with mental illness need to have a greater voice on shaping legislative priorities or health policies, Dr. Janssen adds. “Even though the ACA mandated parity for mental and medical health care, in practice, this is not the case,” he notes.

Spotting the Warning Signs 

Being aware of your child’s mental health starts with paying close attention to their behavior and mood. If you notice changes in your child that last for more than two weeks, this can be a sign of a mental health issue, says Amy Morin, LCSW, psychotherapist, author of “13 Things Strong Kids Do,” and the editor-in-chief of Verywell Mind.

“Kids who are struggling with a mental health issue, like depression and anxiety, may report physical symptoms such as headaches or stomach aches,” Morin adds. “They may also report difficulty sleeping or you may see changes in their appetite.”

Remember, every child is different, and some kids with mental health issues may withdraw socially, while others will act out more. What’s important is being on the lookout for changes that are out of character for your child. 

What This Means For You

If you don’t know how to go about accessing the right help or treatment for your child, a good starting point is reliable resources like National Alliance on Mental Illness (NAMI) or the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment locator. And don’t be scared to put pressure on your insurance company to help you access resources.

Remember, your child’s pediatrician is there to help—they can run initial assessments and help you decide on the next best steps, which may involve seeing a therapist, a psychiatrist, or having a psychological evaluation.

Many community behavioral health centers offer services based on a family's ability to pay, meaning lower income families may not have to pay the full amount. Plus, some schools offer access to therapists, and some communities have free or low cost groups for kids to attend.

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  1. Barican JL, Yung D, Schwartz C, Zheng Y, Georgiades K, Waddell C. Prevalence of childhood mental disorders in high-income countries: a systematic review and meta-analysis to inform policymaking. Evid Based Mental Health. Published online July 19, 2021. doi:10.1136/ebmental-2021-300277