A report states that 63 percent of adolescents with major depression do not receive mental health treatment. (iStock)
Mental treatment in America has a lot of room for improvement. Especially the depression is not sufficiently diagnosed and treated.
The American Academy of Pediatrics took a big step in February to address a deficit – the early detection of depression in adolescents. The group requested that every child over the age of 12 be tested annually for depression.
This could very well catch more symptomatic children and catch them earlier. But once you have a diagnosis in your hand – what then?
Then teenagers and their parents will have a new problem: getting treatment. It's not an easy task to find a provider who can take out your insurance, has availability, is not too far away, has lessons after school, and clicks with your child.
Kate – a mother from Washington who, like other parents in this column, insisted on being identified by just the first name to protect the privacy of their families – was grateful that her family's family doctor prescribed antidepressants when asked her 16-year-old daughter for help. She also knew that her child, diagnosed with severe depression and suicidal thoughts, should go to a specialist. In her town there were two adolescent psychiatrists who could insure themselves privately; however, they had waiting lists of 10 and 12 months.
A Chicago mother had difficulty finding a therapist who took Medicaid for her child, who was depressed and severed herself. "We spent a lot of time working with random therapists who allowed us to pay out of pocket," she wrote in an e-mail. "These people were good, but none were psychiatrists, [so they] could not prescribe medication."
Becky in Connecticut adds another layer to the challenge: "Attempt to select a therapist from a website that provides minimal information on" Teens "," Depression "and" LGBTQ "in the list of specialties and hope that's enough to make a good game. "
These examples are too common a story, as evidenced by a 2017 study. Harvard researchers labeled 601 pediatricians and 312 child psychiatrists in five cities as the parents of a 12-year-old child with depression. Appointments were planned with 40 percent of paediatricians and 17 percent of child psychiatrists. Long waiting times were the good results. Most psychiatric practices did not accept new patients or listed telephone numbers incorrectly.
"Mental health care is not much appreciated," says Paul Gionfriddo, president and CEO of Mental Health America, an advocacy group for patients. Psychiatrists are less paid than most other specialists, and psychologists' rates have fallen in the last two decades. Many therapists have social degrees; They are reimbursed at even lower rates than psychiatrists and psychologists. (These comparisons come from Medicare data, which private insurers often use as a benchmark to set their own rates.) "We do not pay enough to providers, so there are not enough providers," says Gionfriddo.
The latest news from his group report, The State of Mental Health in America, says that 63 percent of adolescents with major depression do not receive mental health treatment. The reports say, "This means that 6 out of 10 young people who have depression and are most at risk of suicidal thoughts, difficulties at school, and difficulties in relationships with others are not receiving the treatment they need."
There are other obstacles that lead from diagnosis to treatment. Parents may not want to believe that their child is depressed. Teens themselves do not always want to take the recommended steps.
There is more than stigma, says Ana Radovic, a specialist in youth medicine at the University of Pittsburgh. One patient did not want Radovic to tell her mother about her diagnosis because the mother was struggling with family issues and the teenager did not want to be any more burden.
Laura in Baltimore says the teenager's biggest problem is talk therapy. "She understood that combining medication with talk therapy was the best way, but she really hated seeing someone every week or every other week," Laura wrote in an e-mail. "At one point she said she would try if the therapist was young and female, which turned out to be quite difficult."
Parents can feel guilty and wonder if their child's problems stem from divorce or parenting , "If you tell a family that your child may be depressed, there are a lot of emotions," says Radovic.
Candace in New York emailed her concerns: "I felt like I was guilty – I had severe weeks after giving birth to depression and anxiety [and] he grew up with it – I was a single mother, I had to work Was not I present enough? "
These deeply personal problems can make it difficult for a family doctor to sign up for a child visit, Radovic says.
If pediatricians regularly seek depression, they will likely identify more adolescents with depressive symptoms. What can these providers do to help families with the next step? Ideally, GP practices would have in-house psychiatric providers or a reference list.
Radovic says a case manager can help follow patients who positively screen and prevent some from falling through the cracks.
Gionfriddo says that it is not only important for physicians to give recommendations for treatment, but also access to information on issues such as depression and anxiety (both often co-exist) and what forms of therapy exist. "Traditional cognitive behavioral therapy is not right for everyone," he says.
Radovic and Gionfriddo say that entertaining teens with other teenagers, such as in group therapy sessions, can be very helpful. Radovic has also developed a website, SOVA (Supporting Our Valued Adolescents), which is a moderated online chat forum for teenagers with depression and / or anxiety.
"Teens who have gone through treatment want to help others," Radovic says. Your team is now exploring results, including questions such as "Will website interaction help children earlier?"
Radovic says she wants people to know that it is normal to resist anxiety and depression relief. Resources and social support can be valuable, she says. "Do not be afraid to ask," Could that be a problem? "It's better to be wrong than to be late."