Panel Discusses Need to Integrate Children's Mental Health, Primary Care

WASHINGTON – Child obesity and overweight are exacerbating the crisis in untreated child mental illness, according to an expert panel of physicians and health leaders.

Nearly 17% of U.S. children and adolescents aged 2-19 years are obese, according to the Centers for Disease Control and Prevention. Meanwhile, an estimated 20% are affected by some type of mental disorder during the lifetime, according to a recent survey by the National Institute of Mental Health. Yet, only about half of young people with a mental health disorder were treated for that disorder in the past year, according to data from the National Health and Nutrition Examination Survey.

"In addition to the increased medical problems associated with being overweight, these children and adolescents suffer from a higher prevalence of psychological problems resulting in poor academic performance, low self-esteem, depressive disorders, and a greater number of suicide attempts," according to officials at Arizona State University, Phoenix, who organized the panel.

"We should not forget that obesity and mental health affects every single segment of our society," said former Surgeon General Richard H. Carmona during the event, titled "America’s Children at Peril: Solving the Child Obesity and Mental Health Epidemics."

"What is lacking in the national agenda is dealing with the mental health and the overweight issue," said Bernadette Mazurek Melnyk, Ph.D., dean and distinguished foundation professor in nursing at ASU.

There are other barriers, including primary care physician shortage, lack of incentives, poor reimbursement, and lack of training, according to the panelists.

Many primary care physicians haven’t been trained in treating children’s mental illness and hence avoid tackling it, said Dr. Peter S. Jensen, president of the REACH Institute and cochair of division of child psychiatry and psychology at the Mayo Clinic, Rochester, Minn. "It’s the fear of the unknown."

Dr. Mazurek Melnyk noted that primary care physicians sometimes avoid diagnosing mental illness, "because if I screen and I find something, I have no one else to refer them to, and I can’t treat them," she said, relating a sentiment she said she often hears at workshops on integrating mental health care into primary care.

She noted that high-profile events like the Tucson, Ariz., shooting that injured Rep. Gabrielle Giffords (D-Ariz.), killed 6 people, and wounded 13 others, remind the nation "that we have a problem. But, [the problem is] highlighted for a week or 2 by the media and then it goes away. It’s always around these events that [the issue] gets attention, but it doesn’t lead to change. [Untreated mental illness] needs high-profile visibility."

Dr. Kyu Rhee, chief public health officer at the Health Resources and Services Administration, said that several factors are needed to help integrate mental health care into primary care:

• research to see what works.

• education on how the health-care workforce is trained and on taking a team-based approach.

• policies on integration from the federal level down to the individual practice level.

Both "mental health and [body mass index] need to be considered as vital signs," Dr. Rhee said. "You need to screen for them, and you need to have a team-based approach. Think about the spectrum of people working with you, from nurses to the front-desk staff, so even though patients have 15 minutes with you, they usually have an hour, an hour and half in the office."

Having a transdisciplinary team is another way to eliminate the lag time between diagnosis of a mental health issue and proper treatment, said Dr. Mazurek Melnyk. "It creates a seamless system."

Dr. Rhee urged physicians to be a part of the solution to the crisis of untreated mental illness. "Approach it as one patient or one community at a time. Build transectoral partnerships with schools and businesses. Think broader than just the exam room. Think more about the prevention paradigm," he urged.

WASHINGTON – Child obesity and overweight are exacerbating the crisis in untreated child mental illness, according to an expert panel of physicians and health leaders.

Nearly 17% of U.S. children and adolescents aged 2-19 years are obese, according to the Centers for Disease Control and Prevention. Meanwhile, an estimated 20% are affected by some type of mental disorder during the lifetime, according to a recent survey by the National Institute of Mental Health. Yet, only about half of young people with a mental health disorder were treated for that disorder in the past year, according to data from the National Health and Nutrition Examination Survey.

"In addition to the increased medical problems associated with being overweight, these children and adolescents suffer from a higher prevalence of psychological problems resulting in poor academic performance, low self-esteem, depressive disorders, and a greater number of suicide attempts," according to officials at Arizona State University, Phoenix, who organized the panel.

"We should not forget that obesity and mental health affects every single segment of our society," said former Surgeon General Richard H. Carmona during the event, titled "America’s Children at Peril: Solving the Child Obesity and Mental Health Epidemics."

"What is lacking in the national agenda is dealing with the mental health and the overweight issue," said Bernadette Mazurek Melnyk, Ph.D., dean and distinguished foundation professor in nursing at ASU.

There are other barriers, including primary care physician shortage, lack of incentives, poor reimbursement, and lack of training, according to the panelists.

Many primary care physicians haven’t been trained in treating children’s mental illness and hence avoid tackling it, said Dr. Peter S. Jensen, president of the REACH Institute and cochair of division of child psychiatry and psychology at the Mayo Clinic, Rochester, Minn. "It’s the fear of the unknown."

Dr. Mazurek Melnyk noted that primary care physicians sometimes avoid diagnosing mental illness, "because if I screen and I find something, I have no one else to refer them to, and I can’t treat them," she said, relating a sentiment she said she often hears at workshops on integrating mental health care into primary care.

She noted that high-profile events like the Tucson, Ariz., shooting that injured Rep. Gabrielle Giffords (D-Ariz.), killed 6 people, and wounded 13 others, remind the nation "that we have a problem. But, [the problem is] highlighted for a week or 2 by the media and then it goes away. It’s always around these events that [the issue] gets attention, but it doesn’t lead to change. [Untreated mental illness] needs high-profile visibility."

Dr. Kyu Rhee, chief public health officer at the Health Resources and Services Administration, said that several factors are needed to help integrate mental health care into primary care:

• research to see what works.

• education on how the health-care workforce is trained and on taking a team-based approach.

• policies on integration from the federal level down to the individual practice level.

Both "mental health and [body mass index] need to be considered as vital signs," Dr. Rhee said. "You need to screen for them, and you need to have a team-based approach. Think about the spectrum of people working with you, from nurses to the front-desk staff, so even though patients have 15 minutes with you, they usually have an hour, an hour and half in the office."

Having a transdisciplinary team is another way to eliminate the lag time between diagnosis of a mental health issue and proper treatment, said Dr. Mazurek Melnyk. "It creates a seamless system."

Dr. Rhee urged physicians to be a part of the solution to the crisis of untreated mental illness. "Approach it as one patient or one community at a time. Build transectoral partnerships with schools and businesses. Think broader than just the exam room. Think more about the prevention paradigm," he urged.

WASHINGTON – Child obesity and overweight are exacerbating the crisis in untreated child mental illness, according to an expert panel of physicians and health leaders.

Nearly 17% of U.S. children and adolescents aged 2-19 years are obese, according to the Centers for Disease Control and Prevention. Meanwhile, an estimated 20% are affected by some type of mental disorder during the lifetime, according to a recent survey by the National Institute of Mental Health. Yet, only about half of young people with a mental health disorder were treated for that disorder in the past year, according to data from the National Health and Nutrition Examination Survey.

"In addition to the increased medical problems associated with being overweight, these children and adolescents suffer from a higher prevalence of psychological problems resulting in poor academic performance, low self-esteem, depressive disorders, and a greater number of suicide attempts," according to officials at Arizona State University, Phoenix, who organized the panel.

"We should not forget that obesity and mental health affects every single segment of our society," said former Surgeon General Richard H. Carmona during the event, titled "America’s Children at Peril: Solving the Child Obesity and Mental Health Epidemics."

"What is lacking in the national agenda is dealing with the mental health and the overweight issue," said Bernadette Mazurek Melnyk, Ph.D., dean and distinguished foundation professor in nursing at ASU.

There are other barriers, including primary care physician shortage, lack of incentives, poor reimbursement, and lack of training, according to the panelists.

Many primary care physicians haven’t been trained in treating children’s mental illness and hence avoid tackling it, said Dr. Peter S. Jensen, president of the REACH Institute and cochair of division of child psychiatry and psychology at the Mayo Clinic, Rochester, Minn. "It’s the fear of the unknown."

Dr. Mazurek Melnyk noted that primary care physicians sometimes avoid diagnosing mental illness, "because if I screen and I find something, I have no one else to refer them to, and I can’t treat them," she said, relating a sentiment she said she often hears at workshops on integrating mental health care into primary care.

She noted that high-profile events like the Tucson, Ariz., shooting that injured Rep. Gabrielle Giffords (D-Ariz.), killed 6 people, and wounded 13 others, remind the nation "that we have a problem. But, [the problem is] highlighted for a week or 2 by the media and then it goes away. It’s always around these events that [the issue] gets attention, but it doesn’t lead to change. [Untreated mental illness] needs high-profile visibility."

Dr. Kyu Rhee, chief public health officer at the Health Resources and Services Administration, said that several factors are needed to help integrate mental health care into primary care:

• research to see what works.

• education on how the health-care workforce is trained and on taking a team-based approach.

• policies on integration from the federal level down to the individual practice level.

Both "mental health and [body mass index] need to be considered as vital signs," Dr. Rhee said. "You need to screen for them, and you need to have a team-based approach. Think about the spectrum of people working with you, from nurses to the front-desk staff, so even though patients have 15 minutes with you, they usually have an hour, an hour and half in the office."

Having a transdisciplinary team is another way to eliminate the lag time between diagnosis of a mental health issue and proper treatment, said Dr. Mazurek Melnyk. "It creates a seamless system."

Dr. Rhee urged physicians to be a part of the solution to the crisis of untreated mental illness. "Approach it as one patient or one community at a time. Build transectoral partnerships with schools and businesses. Think broader than just the exam room. Think more about the prevention paradigm," he urged.