With a shortage of psychiatrists, MI pediatricians take lead in mental health care for kids
Michigan, like most of the country, is in desperate need of more child and adolescent psychiatrists.
A study released in February found that one in seven children in Michigan – more than 100,000 children in total – have been diagnosed with depression, anxiety, or ADHD, which are the three most common psychiatric disorders in people under the age of 18.
The state had a total of just 239 psychiatrists trained to treat children and adolescents in 2017, according to the American Academy of Child and Adolescent Psychiatrists. That works out to just 11 psychiatrists for every 100,000 children across the state.
“It’s a perfect storm,” said Dr. Sheila Marcus, a pediatric psychiatrist at C.S. Mott Children’s Hospital.
Marcus says that many pediatric specialties struggle to attract enough residents. But very few are faced with as high of demand as child and adolescent psychiatrists. In Michigan, Marcus says, more than half of counties – 65 in total – have zero child and adolescent psychiatrists.
For families, this can mean long waiting lists for a first appointment and driving across the state to find appropriate psychiatric care. For some kids, it may mean getting no treatment at all. Around 40 percent of Michigan children diagnosed with the three most common psychiatric disorders (depression, anxiety, and ADHD) get no mental health treatment.
“We know that undertreatment of these illnesses is frankly catastrophic for a child’s trajectory in life,” said Dr. Marcus. "So, things like academic decline, inability to form comfortable intimate relationships, early pregnancy. It’s associated with use of alcohol and drugs.”
The shortage of child and adolescent psychiatrists means pediatricians and other primary care providers often end up being the ones treating children and teens for their mental health issues.
“But many of them feel ill-equipped to do so. And most indicate that they’re spending about 40 percent of their time on mental health issues,” Marcus said.
"We know that undertreatment of these illnesses is frankly catastrophic for a child's trajectory in life."
Marcus is part of an effort to assist those primary care doctors doing the bulk of mental health treatment for kids and teens. She leads the Michigan Child Collaborative Care program, which gives pediatricians across the state access to psychiatric consultation and advice on children’s mental health issues. They can get same day advice on medications, as well as different therapies for that child’s particular disorder. The program has been in place since 2012.
“In a perfect world, we would have enough specialized child psychiatrists to serve children who had more moderate to severe illness. I don’t see that happening, at least within the next decade or so,” Marcus said.
Instead, the MC3 program creates a continuum of care where the most severe cases can be funneled to child psychiatrists, while mild and moderate cases are treated by primary care doctors with expert support.
Marcus says one of the most striking things they’ve found in the course of their work has been that there are a large number of children who are being inappropriately diagnosed with, and medicated for, mental health disorders when the root of their behaviors actually has to do with trauma.
She recalls a call from a primary care provider in the Thumb who was caring for a four-year-old being raised by his grandmother. The child was running into the street, and the grandmother was considering taking him to Grand Rapids to be hospitalized because she couldn't keep him safe. When Marcus started asking questions, she learned that the boy's father was in jail. His mother who was addicted to opioids. The boy had also witnessed repeated instances of domestic violence at home before being put into his grandmother’s care.
“So this child who had been called bipolar and oppositional defiant disorder, and was already on three medications, didn’t have any of those things. This was a child that had suffered from trauma, and this is a story that’s way too common,” Marcus said.
Parents who are having trouble finding mental health treatment for their child should be persistent, Marcus advises. When it comes to finding to an in-patient hospital bed or residential facility, she says explore every option and keep checking back because things can change day to day in the emergency room.
“In the case of waiting lists, put your child on every waiting list that you can. People who are diligent and call frequently do tend to get moved up,” explained Marcus.
Marcus says she does think the situation is beginning to change. She's encouraged to see lawmakers, universities, and primary care providers paying more attention to the issue of children's mental health. Marcus says getting everyone – from schools to police to pediatricians – on board and informed about mental health will be essential to getting kids the help they need.
CORRECTION: A previous version of this post referred to Dr. Sheila Marcus as a pediatric psychologist. That is incorrect. She is a pediatric psychiatrist. The post has been corrected.