The Shortage of Child and Adolescent Psychiatrists

Twelve-year-old Jordan has just experienced a traumatic event and his mother is fearful that he may be experiencing symptoms of Post-Traumatic Stress Disorder (PTSD.) He is having trouble sleeping, he cries hysterically when it’s time to depart for school in the morning, is very jumpy, often has flashbacks of the event, and has become quite irritable. It’s like his entire personality has changed. Jordan’s mother knows that her son needs help but she’s finding it hard to find a child and adolescent psychiatrist in their area. And the few who are within driving distance either do not take her insurance or their appointments are filled for the next six months. She is so distraught and she just doesn’t know what to do.

Unfortunately this is not an uncommon experience for families who have children who need psychiatric treatment. Over the past several years, there has been a steep decline in the number of child psychiatrists in this country and large population of people in need. It is estimated that each year between 14% and 20% of children and adolescents experience a mental, emotional, or behavioral disorder. Despite this documented need for care, it is estimated that 70% of children with a diagnosable mental illness do not receive treatment. Studies have shown that at least 1 in 5 children and adolescents have a mental health disorder that causes some impairment in functioning (approximately 5 students in a classroom of 25). Remarkably, only about 20% of these youths receive any mental health services[1].

Additionally, according to the American Academy of Child and Adolescent Psychiatry, there is only an estimated 6,300 child and adolescent psychiatrists practicing medicine in the United States. The statistics are even worse for children and families who live in rural towns or poor urban areas as there are significantly fewer of these already scarce specialized providers available to people who live in those areas.

The lack of child and adolescent psychiatrists is an urgent problem as it reduces access to crucial mental health care for young people. Child and adolescent psychiatrists undergo two additional years of training so that they are well prepared to handle the specific needs of children. The specialized training of child and adolescent psychiatrists highlights the disorders that that typically appear in childhood such as Autism spectrum disorders, attention-deficit hyperactivity disorder (ADHD), learning disabilities, mental retardation, mood disorders that have a childhood onset, drug abuse, and behavioral disorders such as conduct disorder. In addition, the specialized training that these Providers receive includes a thorough exploration of normal child and family development. It also explores how development goes awry in childhood and shares treatment approaches that work well for children. Child and adolescent psychiatrists are cognizant that treatment for children is often different than treatment for adults, given the social, familial, and environmental components that need to be considered. This distinction is an extremely important component that is often missed when children are unable to receive treatment from providers who are trained to tap into this dynamic.

Like it or not, there is a shortage of child and adolescent psychiatrists in this country. To address the shortage, The American Academy for Child and Adolescent Psychiatry Task Force on Workforce Needs has started a ten year recruitment initiative that involves actively encouraging medical students to pursue this specialization. However, the immediate needs of youth who are experiencing mental health crises still need to be addressed. Here are some potential solutions to address the current shortage:

•One solution is for children to receive treatment from two providers to address their needs. Child psychologists, who specialize in childhood psychological struggles could form partnerships with general psychiatrists to make sure that the individualized needs of children are being met from both a psychological and psychiatric perspective.

•Another option would be to provide mobile services where child and adolescent psychiatrists would travel to various places on a rotating basis to provide services.

•A third solution, and one that is becoming more and more popular, is to offer telepsychiatry services. Telepsychiatry is the use of videoconferencing to provide psychiatric evaluation, consultation and treatment. Telepsychiatry has the potential to better link and enhance the provision of health services, and can be particularly beneficial in addressing geographic distance and/or capacity issues[2]. Providers would be able to provide services to more children in need because travel time, appointment scheduling and caseload would all become less of a hindrance.

shutterstock_171463745 smallFor many children struggling with mental and behavioral health issues, telepsychiatry is an excellent means of providing high-quality care to people who would otherwise go without. Research shows that telepsychaitry is just as effective as treatment provided in person, and some outcomes show that children and adolescents find telepsychiatry visits to be more enjoyable and effective than traditional in-person visits. Telepsychiatry has the potential to better link and enhance the provision of health services, and can be particularly beneficial in addressing geographic distance and/or capacity issues[2]. For example, a study on how effective telepsychiatry is for ADHD treatment in rural areas showed that during the 22 weeks of the study, children who received telepsychaitry treatment improved significantly in ADHD inattention and hyperactivity, oppositional defiant disorder, school performance, and adaptive functioning.

The decline in child and adolescent psychiatrists is alarming and a push toward getting more providers in the field is extremely important. However, there are several adaptive solutions being utilized today that make sure that children can have access to the specialized psychiatric services that they need.

[1][2] Child and Adolescent Psychiatric Clinics of North America, 2011-01-01, Volume 20, Issue 1, Pages 81-94

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