Mental health services for children and adolescents: Missed opportunities in primary care & barriers to specialty care

December 15, 2008 Volume 5 Issue 4
  • 56% of parents say that their children's primary care doctor never asks whether they have concerns about their children's mental health.
  • 1 out of 4 parents have used specialty mental health services for their children.
  • 1 out of 5 parents have children with a mental health diagnosis.
  • 25% of parents with children who have a mental health diagnosis report trouble getting specialty mental health services for their children.

Children and adolescents may have mental health concerns that affect the way they act, feel and think. Some mental health concerns can be addressed by primary care doctors (for example, pediatricians and family doctors) who take care of general medical problems. In some cases, children and adolescents may also benefit from specialty mental health services provided by professionals such as psychologists, psychiatrists and social workers.

In August 2008, the CS Mott Children's Hospital National Poll on Children's Health asked parents with children age 5-17 years about mental health concerns for their children who have been diagnosed with a mental health condition.

Mental Health Concerns and Primary Care

Over one-half of parents report that their children’s primary care doctor never asks whether they have concerns about their children’s mental health. About one-fifth of parents say that their children’s primary care doctor regularly asks about mental health concerns (Figure 1).

One-third of parents have talked with their children’s primary care doctor about a mental health concern, and the majority of these parents (22% overall) have discussed such concerns within the past year.

Use of Specialty Mental Health Services

One out of four parents have used specialty mental health services for their children (Figure 2), and most of these parents (15% overall) have used specialty mental health services within the past year.

Among parents who have discussed mental health concerns with their children’s primary care doctor, 62% have used specialty mental health services for their children.

Mental Health Conditions for Youth

One out of five parents indicate that one or more of their children age 5-17 years have been diagnosed with a mental health condition. Mental health diagnoses included attention deficit hyperactivity disorder (ADHD/ADD), behavioral problems, autism, depression, alcohol and drug use, bipolar disorder, and eating disorders. The three most common mental health diagnoses for children age 5-17 years were ADHD/ADD, behavioral problems and depression.

Difficulties Getting Specialty Mental Health Services

Parents were asked if there has been a time when they could not get specialty mental health services that they wanted for their children. Overall, 7% of parents say there has been a time when they could not get the specialty mental health services they wanted.

Among parents who have a child that has been diagnosed with a mental health condition, 25% have experienced a time when they could not get the specialty mental health services they wanted. In contrast, among parents who do not have a child with a diagnosed mental health condition, 3% indicated there was a time when they could not get the mental health services they wanted.

For those parents who say there has been a time when they could not get the mental health services they wanted for their children, nearly one-half said the reasons were that it was difficult to find a provider or that it costs too much, and about one-third said they could not get an appointment in a timely fashion or did not know where to go for specialty mental health services (Figure 3).

Insurance coverage was also a concern for some parents. Overall, only 45% of parents report having full coverage for mental health services, 20% have limited coverage, 8% do not have any coverage and 27% of parents were unsure about mental health coverage.

Implications

According to national estimates, one in ten children and adolescents in the United States suffer from a serious emotional disturbance. And other studies, including this poll, show that at least one out every five children have mental health disorders. Children and adolescents with mental health concerns should get help from health care providers as soon as possible.

With such a high prevalence of mental health concerns, it is concerning that about one-half of families report that their children’s primary care physicians do not ask about mental health issues during office visits. It appears that primary health care providers may be missing opportunities to identify children and adolescents with mental health problems and to help parents understand treatment options.

Not surprisingly, a substantial proportion of parents of children with mental health concerns in this poll reported that they have had difficulty accessing specialty mental health care for their children. The shortage of specialty providers is a known problem in the United States, but parents also reported trouble with the costs of care and insurance coverage. Such challenges underscore the importance of primary care in addressing mental health issues for youth.

Data Source

This report presents findings from a nationally representative household survey conducted exclusively by Knowledge Networks, Inc, for C.S. Mott Children’s Hospital via a method used in many published studies. The survey was administered from August 1-31 to a randomly selected, stratified group of adults aged 18 and older (n=2,245) with and without children from the Knowledge Networks standing panel that closely resembles the U.S. population. For this analysis, a subset of parents with children age 5-17 years was used (n=1,473). The sample was subsequently weighted to reflect population figures from the Census Bureau. The survey completion rate was 62% among panel members contacted to participate. The margin of sampling error is plus or minus 2 to 11 percentage points, depending on the question.

C.S. Mott Children’s Hospital National Poll on Children’s Health
Director: Matthew M. Davis, MD, MAPP
Associate Director: Sarah J. Clark, MPH
Manager & Editor: Dianne C. Singer, MPH
Data Analyst: Amy T. Butchart, MPH

This Report includes research findings from the C.S. Mott Children's National Poll on Children's Health, which do not represent the opinions of the investigators or the opinions of the University of Michigan. The University of Michigan reserves all rights over this material.

Survey Questions — For parents with children age 5-17 years

The term “mental health” includes a wide variety of issues, such as attention and behavior issues, alcohol and drug abuse, autism, anxiety, depression, bipolar disorder, personality disorders, and schizophrenia.

Some mental health concerns can be addressed by primary care doctors who take care of general medical problems. There are also specialty mental health services provided by professionals such as psychologists, psychiatrists and social workers.

We are interested in learning about how your child(ren) and you may have used primary care and specialty mental health services in the past.

Q1. When was the last time you talked with a child(ren)’s primary care doctor about mental health concerns that you had for your child(ren)?

  • Within the last year
  • Within the last 2 years
  • Within the last 5 years
  • More than 5 years ago
  • Never

Q2. How often does your child(ren)’s primary care doctor ask whether you have concerns about
their mental health?

  • Regularly
  • Sometimes
  • Never

Q3. When was the last time your child(ren) used specialty mental health services (e.g., psychologist, psychiatrist)?

  • Within the last year
  • Within the last 2 years
  • Within the last 5 years
  • More than 5 years ago
  • Never

Q4. Has there been a time when you could not get specialty mental health services that you wanted for your child(ren)?

  • Yes
  • No

[If Q4=Yes, then Q5]
Q5. Why could you not get specialty mental health services for your child(ren)? (Select all that apply)

  • Costs too much
  • Difficult to find a provider
  • Could not get an appointment in a timely fashion
  • Did not know where to go
  • Could not get child to go for services
  • Other [write-in]

Q6. Which best describes your oldest child’s health insurance coverage for mental health services?

  • Covered in full
  • Limited coverage
  • Not covered
  • Unsure

Participants were also asked demographic questions on age, gender, health status, annual household income, education, race/ ethnicity, health insurance status and the presence ofchildren in the household. Parents were also asked questions regarding child(ren)’s age, gender, health status and diagnosed health conditions.

All information is the sole property of the University of Michigan CS Mott Children's Hospital National Poll on Children's Health. It can only be used if there is an acknowledgment that "The information came from, is copyright by and is owned by and belongs to the Regents of the University of Michigan and their C.S. Mott Children's Hospital National Poll on Children's Health. It cannot be republished or used in any format without prior written permission from the University."

C.S. Mott Children’s Hospital National Poll on Children’s Health
Director: Matthew M. Davis, MD, MAPP
Associate Director: Sarah J. Clark, MPH
Manager & Editor: Dianne C. Singer, MPH
Data Analyst: Amy T. Butchart, MS

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How often children's primary care doctor ask about their mental health
Parents who have used specialty mental health services for their children
Reasons parents could not get specialty mental health services for their kids