Atlanta and the state of Georgia stand at an historic moment of both crisis and opportunity for the mental health of its current generation of children.
In 2021 more than 100,000 Georgia students reported feeling depressed, sad, or withdrawn and the rates of depression are rising. Nationally, one in six children has a behavioral, mental, or developmental disorder and one out of every 11 adolescents has attempted suicide. Untreated, these conditions contribute to the leading causes of death for youth, as well as school failure, substance abuse and encounters with the juvenile justice and criminal justice systems.
Credit: COURTESY
Credit: COURTESY
The Atlanta Journal-Constitution has also sounded an alarm about the level of appropriate care for children who require inpatient or institutional care to assure their safety. The current state of inpatient care, however, is just a symptom of a system in crisis, one that is undergoing a perfect storm of rising incidence and severity, post-pandemic workforce shortages and turnover, cost escalation and a decades-long shift of mental health professionals’ effort toward people who can afford to pay for care out-of-pocket, which disadvantages lower-resourced families and children on governmental insurance.
There are major gaps in prevention and outpatient treatment services for children, which highlight the need for a comprehensive system of care. To address the crisis, it is simply not enough to focus on the few days that a child resides in an inpatient facility until it is safe to return home.
Typically, mental health conditions culminate in crisis after years of missed opportunities for interventions that have been proven effective, and in the aftermath of every crisis, children typically require weeks to months of effective outpatient care to recover. It is a fact that the vast majority of deaths and severe injuries attributable to mental health conditions occur outside of inpatient psychiatric facilities, as children languish on extended wait lists for recovery care or when their conditions are never identified or treated in the first place. Unfortunately, a disproportionate share of what is spent nationally in child mental health is spent on inpatient or institutional care that could have been averted by earlier, far less expensive and more effective treatment.
Two unprecedented developments have put us in a position to lead the nation by effecting a sea change for the mental health of children of our state. First, the board of Children’s Healthcare of Atlanta dedicated one of the largest endowments ever designated by a U.S. health system – more than $550 million -- for the purpose of advancing child mental health. Secondly, House Bill 1013, the state’s Mental Health Parity Act, was unanimously passed to help ensure that standards for reimbursing the true costs of mental health care — and for supporting adequate numbers of workers to deliver it — are on a par with other types of medical care.
The plan Children’s Healthcare of Atlanta has put into action builds on these two important developments and focuses on the continuum of care needed by kids – prevention, intervention, crisis care and ongoing recovery services. The goal is to sustainably supplement the existing service structure by filling or collaboratively improving the most critical gaps, with quality and equity for all children as first principles.
We must work together, leverage existing programs of high quality, heed the scientific evidence for what is known to be effective and balance the investment of new resources across the complete continuum of opportunity. We need to provide kids a comprehensive path forward from crisis through the longer road of evidence-based recovery, and to lead a quantum leap in service delivery statewide that will help keep them from slipping through cracks.
This will take our entire community working together – from mental health providers, state government and other community support organizations – each entity plays a critical role. Together, we will demonstrate to the nation what is possible for health systems and communities to do: which is to deliver effective, necessary mental health care to all children.
We are committed to this agenda, poised to partner with our community in a strategic transformation of children’s mental health and, as has been our custom in all other aspects of child health, never to give up until, collectively, we succeed.
John N. Constantino, M.D. is chief, behavioral and mental health, for Children’s Healthcare of Atlanta.
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