Is the Mental Health System Failing Troubled Kids?

Spotting, managing young people like Adam Lanza is difficult and will take more resources, experts say

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By Amanda Gardner
HealthDay Reporter

TUESDAY, Dec. 18 (HealthDay News) -- In the aftermath of the mass shooting that claimed the lives of 20 children in Newtown, Conn., last Friday, voices around the nation are asking, "How could this have happened?"

At the heart of any answer is the psychological makeup of Adam Lanza, the 20-year-old shooter who forced his way into Sandy Hook Elementary School before gunning down the young students and six adults. Earlier that morning, he shot and killed his mother in the home they shared.

Details of Lanza's mental health issues are still emerging, but it's clear he was a troubled child and young adult. As reported by ABC News, typical comments by people who knew Lanza included "weird kid," "not well" and "hated looking at your eyes."

Mental health experts stressed that merely noting that a child seems "weird" is not enough to mandate that he or she seek care. Most agree, however, that children and young people with mental health issues across the United States are falling through the cracks of an inadequate system.

According to the U.S. National Institute of Mental Health, half of all cases of mental illness begin to develop before the age of 14. Despite this, the United States has a dire shortage of child mental-health providers, said Dr. Howard Liu, medical director of the Behavioral Health Education Center of Nebraska at the University of Nebraska Medical Center in Omaha.

As far back as 2007, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) commissioned a report looking at the issue. "This report found that there were many gaps in the mental health system, including a critical shortage of all child and adolescent providers," Liu said.

In the report's words, "There is a critical shortage of individuals trained to meet the needs of children and youth, and their families. As just one example, the federal government has projected the need for 12,624 childand adolescent psychiatrists by 2020, which far exceeds the projected supply of 8,312. There currently are only 6,300 child and adolescent psychiatrists nationwide, with relatively few located in rural and low-income areas."

The SAMHSA report specifically pinpointed the lack of trained mental health professionals active in the nation's schools, saying that this type of staff are "in significantly short supply, or are hindered by the constraints of their position to use such skills."

Liu says he deals with these types of shortages every day -- in Nebraska, for instance, there are only 30 child psychiatrists in the entire state, or one for every 11,000 children.

Another expert agreed. "In most places around the country, wait times to be seen by a mental health professional are many months long," said Eric Butter, associate director of the Child Development Center at Nationwide Children's Hospital in Westerville, Ohio.

In addition, many health insurance companies do not adequately cover mental health services, Butter noted. This means that people have less access to the psychologists, counselors, clinical social workers and other medical professionals who could prevent them from harming themselves or others.

Both experts stressed that the vast majority of mentally ill people will not act out violently. So spotting and managing those very few who might becomes a hugely difficult task.

"There are several forensic tools which are used in threat assessment for violence, but as any individual working in behavioral health knows, these are imperfect tools which can only give the clinician a general idea of risk," Liu said. "They are certainly no crystal ball for any specific individual."

According to Liu, one study looking into the issue of "risk assessment" for people with schizophrenia, for example, found that to prevent just one homicide a total of 35,000 people with schizophrenia would need to be detained. That is "simply not a reasonable thing to do while respecting our citizens' civil rights," Liu said.

Simon Rego, director of psychology training at Montefiore Medical Center/Albert Einstein College of Medicine in New York City, agreed. "It remains extremely difficult to predict such violent actions," he said.