There’s been an increase in reported rates of mental illness in children and teenagers according to the Center for Disease Control. But it’s not clear whether this is due to an actual increase in mental illness or better recognition and diagnosis. Many things may contribute, including social media, problems with sleep and activity caused by heavy use of electronic devices, stress caused by a rapidly changing society, or unknown environmental factors. Unfortunately, there is not enough scientific evidence to let us know why there appears to be an increase.

The number of kids receiving crisis care has really skyrocketed. We’ve been very deliberate in this county about creating access points to go into various systems and identify children. We’re seeing more children with behavioral health crises maybe as a result of identifying them sooner.

From a school’s perspective, in communicating with teachers and other school staff, they’re definitely seeing an increase in incidence. They’re begging for information about mental health and how to identify and support students in the classroom because they have so many kids who are affected.

My first 10 years of practice I saw two, maybe three kids with autism. Now I’m diagnosing one about every three months. One specific area (of concern) is an increase in screen time. There’s a real disconnect with face to face time. And then people watching screens are not going to sleep in the evening when they normally would be going to sleep, resulting in more fatigue in the daytime and at school. The icing on the cake is cyber bullying. I think that’s another issue that increases the incidence of pediatric mental health problems.

Systems that should be partnering, but operating in silos. There’s been a lot more collaboration across systems lately… but at the end of the day, many (systems) still operate in their own silos and still make a decision based on, ‘This practice is best for the kids in our care.’ And then another (system) says, ‘Oh, but this practice is best one for the kids in our care.’ We are working toward even more collaboration and perhaps a commitment/ agreement to what we view in the community as best practices… figuring out what we really want to move forward with. I think it’s confusing for children and families who are in multiple systems to get one thing at one place, and then go get another thing somewhere else. It’s contradictory treatment.

Accessing services. As we all know, there is often a long wait to get in for services. Also, the availability of evening or weekend appointments is limited. A lot of families are really hesitant to pull their kids from school to come to an outpatient appointment and schools are hesitant to pull kids out of class to participate in prevention services.

The funding mechanism (for our business) is very difficult with the aspect of being able to wade through regulations and paperwork. These agencies are extremely difficult to run. It can be quite difficult to run these businesses and difficult to find the staff, let alone retain the staff.

Finding enough people to meet the need. We are finding it harder and harder to find people who are willing to get graduate degrees and take on that debt and then get into a career that pays them very, little, and it is high stress. It’s a rewarding career in many ways, but the stress level can be high without enough benefits to off-set the work.

When I came here, there was a huge concern about a lack of inpatient beds for kids and not enough access to crisis services. That’s an area we’ve been trying to address in partnership with Ohio State. Access to outpatient care is also a real issue. As you develop those crisis and high level services, it diverts resources from outpatient services, and it’s a difficult balance to try to address all of these issues. If we focus on just one gap, we might make some other worse, which is a concern.

We absolutely need to continue to increase our investment and focus on early childhood mental health. At the other end of the spectrum, we’re seeing a lot more kids hospitalized at the highest level care. I believe we still have a gap for intensive community-based care. We don’t have enough (resources) for kids coming out of the hospital. The other need is for more crisis respite. When a youth is in crisis, particularly a younger child, the parents need a break, but they (the kids) don’t need to be hospitalized. Another gap comes with AOD (Alcohol and other Drugs) treatment for all youth. We’re have been seeing and hearing about more and more kids in high school addicted to opiates.

I think another gap is knowledge of resources in the community. There a lot of agencies that are doing good work, but other agencies may not know of this work. With increased communication and knowledge of resources, we can help match youth with the right program. Also, a location for detox of teens is needed.

Increasing services. You increase services for diabetes, and you increase services for other physical illnesses, so why are we not simultaneously increasing access to services for brain health? It can translate to a lifelong need for our children as well as physical illnesses. All these agencies want productive Ohio citizens and well- trained workers. Well, we’re not going to have it unless we look at our zero to three-year-olds and build that foundation on a solid rock rather than sand.

Kids need treatment, and if they can get it when they’re in school, they’re more likely to be able to access it. Parents are still resistant, even if they know their child needs some sort of intervention. They’re also resistant to taking them to a community mental health center due to the stigma. Meeting children’s needs where they are most often– whether that be a pediatric office, a school or a summer program is a safe start to getting them the treatment or care they need.

You go to your primary care doctor with an orthopedic injury, and a referral is made to physical therapy. If you have diabetes, a referral is made to a dietician. We see those referrals as being essential to having good outcomes for those problems, but we don’t see behavioral health treatment as being essential to good outcomes for so many different disorders, which it is. Why has it not been embraced? Unfortunately, I think that relates to stigma.

For us to advance in the field, we need to fight this stigma and have an adequate workforce to meet the growing need we are seeing. Currently, we have shortages in almost all areas of the behavioral health workforce. Individuals in behavioral health are compensated at lower salaries than individuals with similar degrees in other fields. Improving compensation is just one way to increase resources and get more treatment for youth.

For substance abuse services, I wonder whether there could be a central clearinghouse where you could figure out where there are openings or where the best care might be available. It would be collaboration from all relevant agencies to funnel into one central place. A place where a small number of people, who are working together, would know what is available and what specific kinds of services there are by having visited all those places - so they can quickly figure out the best match for the care of a child or teenager with a substance abuse issue.

Engage the community. I think not only talking to the teachers, the students, the parents, but also the community and really finding creative ways to engage the community in regards to awareness is important.

As students learn it, they go home and share the message; Then parents are sharing amongst each other at the natural places: at the coffee shop, at the church, wherever. So a grass roots effort is part of getting rid of the stigma. It was the parents, at the grass roots level, that brought autism to the forefront. You can see the broken arm, and the physical characteristics of obesity and Down syndrome. You can’t see the broken brain. One cannot “see” mental health or mental illness; therefore, it’s hard to put it on a TV commercial.

I like the idea of using the medical model (to explain mental illness) just like you’d use it for Type 1 Diabetes, arthritis, etc. That’s what I use with parents if I’m sitting down and doing a consult for depression or ADHD. By explaining that it is OK to use medication, it helps them understand the medical model. I take the time to fully explain how the medication works and that these are very treatable conditions, like any other ‘medical condition.’ It’s how we use our language. ‘You’re not depressed. You may have depression.’ I think we must keep chipping away and reducing stigma.

I think the more you educate people on brain science, the more you remove the character flaw piece of mental health. It takes a lot of the moral judgment out of it.