Nurturing Mental Health in Children
Mahoney, Diana, Clinical Psychiatry News
Half of all lifetime cases of mental illness begin by age 14.
This observation from a study by Harvard University's Ronald C. Kessler, Ph.D., and his colleagues, in addition to findings that early identification can prevent years of suffering and the risk of illnesses becoming more severe and treatment resistant, speaks to the need for interventions that promote the psychosocial well-being of children (Arch. Gen. Psychiatry 2005;62:593-602).
Children are vulnerable when it comes to mental health. According to estimates from the National Institute for Mental Health Methodology for Epidemiology of Mental Disorders in Children and Adolescents study, almost 8.4 million U.S. children aged 9-17 suffer from a diagnosable mental or addictive disorder associated with at least minimum impairment. About 4.3 million children suffer from a mental illness that results in significant impairment, and 2 million suffer from extremely severe functional impairment.
And 6.5 million of these children--according to the 2000 "Report of the Surgeon General's Conference on Children's Mental Health"--are not getting the help they need. Child health advocates say proactive measures are needed to protect the mental health of this population. And these measures should start in infancy.
Toward that end, a 2005 National Center for Infant and Early Childhood Health Policy report on clinical mental health interventions for children recommended integrating infant mental health into all child and family service systems. "Enhancing relationships between infants, parents, caregivers, and service providers through supportive child and family service systems is a key to success in infant mental health," the authors wrote (www.healthychild.ucla.edu/publications/NationalCenterPubs.asp).
Additional policy recommendations from the report include:
* Identifying mental health disorders in young children and their families.
* Ensuring that young children and families at high risk have access to and receive comprehensive mental health services.
* Raising public and professional awareness about the importance of early social and emotional development.
* Developing strategies for assessing outcomes and program evaluation.
The degree to which these recommendations can be put into practice is difficult to quantify. To a large extent, Dr. Kessler said in an interview, "It boils down to simple accounting questions: Do we have interventions that are known to have more good than bad effects and to have effects [for which] the amount of good justifies the cost?"
The answer is yes but only if you know where to look. In San Francisco, for example, a Department of Public Health (DPH) program called First 5 San Francisco funds community-based mental health consultation services for young children and their families that are offered through eight child care agencies in the city. Outcome data from a 2005 DPH evaluation showed that children with significant socialization delays at baseline who received mental health consultation services through the program demonstrated significant increases in socialization scores at 6 months.
The First 5 program also offers mental health consultation services to children living in homeless shelters, domestic violence shelters, and transitional housing facilities. In the 2005 evaluation, baseline assessments of these children showed symptoms of anxiety, hyperactivity, aggression, and sleeping and separation difficulties. To address those issues, the program engaged the children in psychotherapy and play groups, and provided parent intervention training.
A second intervention model that has been successfully implemented in the community is the Nurse-Family Partnership (NFP) program, which provides first-time, low-income expectant mothers with home visitation services from specially trained public health nurses. The nurses work intensively with the mothers to improve prenatal, maternal, and early childhood health and well-being, starting 20-28 weeks into the first pregnancy. …