Tara Roberts has two children who both struggle with emotional and behavioral challenges. But the single mother says her biggest challenge is finding sufficient help for her youngest, who is now 18.
“He has ADHD, OCD, ODD, generalized anxiety disorder, Tourette’s, migraines, and just recently had a traumatic brain injury,” said Roberts, who lives in Jackson, Mississippi, and works for Families As Allies, an organization that helps parents and caregivers of children with mental health challenges.
Throughout elementary, middle and high school, her son saw a licensed school therapist. But now that he has graduated, that care has dried up. Roberts’ son sees a neurologist, as well as a nurse practitioner at the local mental health clinic, who only has time to meet with him for maybe 10 minutes and isn’t able to do much more than adjust his medication if he needs it.
“One time we had to go the mental health center, and probably about two days before they had to cancel his appointment. I was like, y’all cancelled his appointment, but he is about to be out of medication. What am I supposed to do?” Roberts recalled. “He is not one of those who should be off his medication at any point in time.”
After that incident, she contacted her son’s family doctor to see if he’d be willing to see them every few months to at least try to fill the gaps in his care. But it is not nearly enough.
“It leaves those things that he is struggling with on a daily basis to be suppressed,” Roberts said.
And she and her son are far from alone. A new study published Monday in the journal Pediatrics highlights the urgent, unmet need for more pediatric mental health providers in this country.
Between 2007 to 2016, the number of child psychiatrists in the United States increased by more than 20% — from roughly 6,500 to nearly 8,000, the study found.
But experts say those gains are nowhere close to meeting current needs. It is estimated that 17 million children in the U.S. have a diagnosable psychiatric disorder.
The moderate improvement means that in 2007, there was 1 child psychiatrist for every 12,477 children. By 2016, it was up to 1 child psychiatrist for every 10,256.
“The math doesn’t add up,” said study author Ryan McBain, a health policy researcher with RAND, a nonprofit think tank. “We need more.”
The study also shows there is huge regional variation in the number of providers, suggesting that access to mental health services is dependent on where children happen to live.
Seventy percent of counties in the United States are without a single child psychiatrist. And the shortage is particularly acute in areas with lower income and education levels.
“If you live in a county that is in the top quarter for income, then you’re on average going to have about three to four times as many times child psychiatrists than if you live in the bottom 20%,” McBain explained.
“Those disparities are sort of rolled up at the state level too,” he added. “So if you take a state like Massachusetts, for example, it has roughly the same number of child psychiatrists as Oklahoma, Indiana, Georgia, Mississippi, and Tennessee combined. And that’s despite the fact that those other states have about five times as many children as Massachusetts.”
“It would be unimaginable that this would be happening in cardiac care. If we couldn’t find enough cardiologists for people having heart attacks — what?! It's unimaginable.”
The new study focused specifically on child psychiatrists, who are, of course, not the only mental health providers who can work with children. Psychologists, social workers, nurse practitioners, pediatricians, and other trained mental health providers can also treat certain issues. But there is little reason to believe that this is an isolated shortage, specific to psychiatrists. The U.S. has a well-documented shortfall of mental health providers, particularly in rural areas. And prior research shows that areas that do not have any psychiatrists also tend to lack any psychologists or psychiatric nurse practitioners.
“This is not an acceptable situation that we have. We have a gross shortage of the most trained people at a time of high suicide,” said Dr. Ken Duckworth, medical director of the National Alliance of Mental Illness, referring to recent Centers for Disease Control numbers showing there has been an uptick in adolescent suicides. “It would be unimaginable that this would be happening in cardiac care. If we couldn’t find enough cardiologists for people having heart attacks — what?! It’s unimaginable.”
Experts are looking into possible fixes such as integrating mental health in pediatric primary care settings, in schools, and in promoting telephone consultations with psychiatrists, as well as telepsychiatry — basically, videoconferencing with a provider. Family-driven practices, such as Families as Allies in Mississippi, aim to help fill in gaps in care, by providing families with information and connecting them with other parents who have been in their situation and who can provide guidance and practical advice.
The authors of the new study also make fleeting mention of the potential role of loan forgiveness programs, given that the average medical student graduates with roughly $190,000 in debt, which may make them less likely to take lower paying psychiatry roles in rural or poor areas.
But for now, the shortage presents a daily challenge to parents living in parts of this country where there simply is not enough help, and where finding care for children who need it is a relentless struggle.
“I work during the day, and then at night it is like I have no life,” said Roberts. “I love my child more than anything, more than my own life. But the struggles are real.”