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Health Care for Children Woefully Inadequate

By Margaret Markham

In the continuing uproar over health care reform, there’s been scarcely a mention of today’s far from ideal state of child health care — with needy children still faring the worst. Nowhere is this more so than for those with mental illness, claims bestselling author Judith Warner in her new book, We’ve Got Issues (Penguin Group, NY).

Despite advances in treating and educating such challenged youngsters, there still are “millions of children in our country who are suffering from mental disorders,” notes Warner, formerly Newsweek’s Paris correspondent. She blames the dilemma on the fact that “progress has been betrayed by both commercial interests and political compliance.”

Warner minces no words about what’s driving the mental health care of kids today. She points to “the bottom line cost control measures decided upon by health insurance companies.”

Her extensive research, the author relates, awakened her to the realization,  “There are virtually no guidelines, no gatekeepers other than the insurance companies, who essentially create protocols for care according to what they will pay for. The net result is that parents feel they’re all alone, navigating an all but non-existent child mental healthcare system.”

Perhaps the most hotly contested debate in child psychiatry today, Warner writes, is whether there are, in fact, more bipolar children now or whether large numbers of children are just inappropriately diagnosed with this disorder and accordingly medicated.

Over the past two decades, in the most serious cases insurance companies have stopped paying for long-term inpatient care for mentally ill children. As a result, psychiatric hospitals have been steadily closing, and residential treatment programs for the most difficult children, where tuition is most often paid with public funds, are packed. Now that more children are being diagnosed than ever before with learning disabilities and other mental health needs, many states can’t keep up with the demand for services.

It can cost up to $150,000 a year to educate a child with extreme special needs, Warner reports. She cites a 2007 survey disclosing how hundreds of thousands of Texas kids don’t get needed special ed services “because the state just isn’t doing its job in reaching out to identify them.”

Special education is mandated by federal law, guaranteeing to all children regardless of the kind of disability the right to “a free, appropriate education.” Nonetheless, that rightful aid has never been adequately funded.

Worse still, as the demand for such identified services has been steadily rising, school budgets are pinched to meet that challenge. Accordingly, school administrators tend to switch funds from other programs to comply with the legal demands of special education pupils. In a recent study, two thirds of children with ADHD who got top-notch care improved so much that their behavior was within normal bounds. On the other hand, Warner found in an interview with Peter Jensen, former associate director of child and adolescent research at the National Institute of Mental Health, those under less adequate health care fared far worse.

Children with similar disorders but under less-privileged circumstances in their own communities, where they saw pediatricians only about twice a year but got some kind of therapy and “haphazard medications” from their regular doctors, were far from a most favorable outcome.

Warner also cites a 2008 survey by Newsday which disclosed five times as many students labeled “autistic” in affluent areas of Long Island as in less well-off communities.

How come?

“New York State’s push to expand special education help for autistic children had pretty much entirely passed by those disadvantaged community children,” she writes.

On top of that, the author notes, “Poorer children who were not being taken for regular pediatrician visits were not getting diagnosed early. And poor and minority children were still being classified as mentally retarded.”

In the view of the author, “There is much about our current culture of childhood and the climate of contemporary family life generally that should raise alarms.” To make matters worse, Warner cautions, “Children with mental disorders have become pawns in much wider adult conflicts.” These include disputes about psychology versus psychiatry, about education and competition, and even about the very nature of childhood and what’s generally viewed as the sorry state of modern parenting.

To be sure, today’s cultural climate often leaves parents “utterly isolated,” and even now with more help available than ever before, “parents still feel lost… families are still stigmatized, and our society is still not doing all it can to give children with mental health challenges the childhood they deserve.”

Margaret Markham, an award-winning science writer and editor, has lived in Las Cruces for 30 years and last year was honored by the City of Las Cruces, which proclaimed Margaret Markham Day on Sept. 8, 2009 in recognition of “her life contributions and achievements.”

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