A Childhood Epidemic We Can No Longer Ignore

By Paul Raeburn

This week, the U.S. Food and Drug Administration convened a panel to address one aspect of an epidemic that rarely makes the headlines. That's partly because it's a problem our society is still uncomfortable talking about -- mental illness in children.

The real tragedy of this neglected epidemic unfolds on lonely, brittle nights, when a child in the grip of a manic outburst runs out of the house toward the street, threatening to jump in front of a passing car. Or when a depressed teenage girl, whom you've already tucked into bed, slips out, quietly takes a bottle of pills from the medicine cabinet and swallows them. Or when parents, doubled over by guilt, call the police to take away a child they can no longer control. Or, most tragically, when a child's suicide attempt is successful.

The FDA is considering whether antidepressants might raise the risk of suicide, especially in children and teenagers. It will consider the recommendations of a panel that advised this week that the strongest possible warnings be put on the drugs. But in the end, the FDA will make an educated guess -- because the research to answer the question conclusively has not been done.

The agency's dilemma highlights what researchers, psychiatrists and especially parents have known for a long time: The nation's system for taking care of children and adolescents with mental illness has been a monumental failure.

A failure of care

About 7 million children and teenagers in the USA suffer from a mental illness severe enough to significantly affect their lives, the U.S. surgeon general says. And in any given year, only about 20% of those children with severe mental illness receive any specialty care.

Yet the recitation of statistics, as alarming as they are, does not convey the suffering of children with mental illness and their families. It is something that only those of us who have children with mental illness can truly understand.

Two years ago, President Bush convened a panel and charged it with analyzing the nation's mental health care system and providing recommendations to fix it.

A year ago, the commission presented a report concluding that the U.S. mental health care delivery system "is fragmented and in disarray." Treatments and services based on rigorous research "languish for years," the panel found. In the year since that report came out, Congress and the White House have done nothing to act on its conclusions.

At a minimum, Washington could require that insurance companies cover mental illnesses at the same level at which they cover other illnesses. Coverage for depression, schizophrenia and bipolar disorder has always been less extensive than coverage of cancer and diabetes. Now the situation is getting worse.

The wrong direction

The increasing reliance on managed care has hit mental illness harder than it has other ailments. In recent years, spending on mental health has declined "much faster" than expenditures for other conditions, the surgeon general found.

Studies have shown that mental illness is best treated with a combination of medicine and talk therapy. In August, researchers reported that Prozac is effective in the treatment of children and teens with depression. The federally funded study also found that a combination of Prozac and talk therapy was even more effective than either one alone.

But only a handful of children are likely to benefit from these findings. Limitations on insurance coverage have pushed doctors to rely more heavily on drugs, which are cheaper than therapy.

Last year, researchers at the University of Maryland found that the use of antidepressants and other psychiatric drugs in children and adolescents more than doubled from 1987 through 1996. Most of these drugs have not been tested in children. What effect will they have on the fragile, still-developing teenage brain? Researchers cannot say. We are in the middle of a vast, uncontrolled experiment, and the guinea pigs are our mentally ill children.

Help for these children is long overdue. One study of one antidepressant must not obscure the need for hundreds more, and for a health care system that will translate those findings into treatments for sick kids who need help now.

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Paul Raeburn is the author of Acquainted with the Night, a memoir of his experiences with his children's mental illness.