My November 2006 editorial addressed the role of primary care nurse practitioners (NPs) in mental health screening and assessment of adult patients. Although adults were the population I chose to discuss at the time, national attention began to focus on violence by troubled teens in our nation's schools1. These events had been happening for many years and continue today. Lately, children committing suicide as a result of bullying has been particularly prominent in headlines—especially cyberbullying over the Internet. As the new academic year begins, parents, teachers, healthcare providers, and other people who work with children are all reminded of the concern for our children's mental health.
Advocacy groups and proposed and/or enacted legislation have grown in some states. The National Alliance on Mental Illness (NAMI) reports the following statistics from several sources concerning the mental health of children:
* Four million children and adolescents in the United States live with a serious mental disorder that causes significant functional impairments.
* Twenty-one percent have a diagnosable mental or addictive disorder that causes at least minimal impairment.
* Half of all lifetime cases of mental illness begin at age 14.
* Despite the availability of effective interventions, there are long delays (sometimes decades) before the diagnosis of a mental health problem and initial intervention—which leads to more severe diseases and difficulties in treatment.
* Only 20% of children with a mental disorder receive mental health services.2
Screening and identification of mental disorders in children and adolescents, and initiating appropriate interventions, should be an integral part of all primary care visits. Most children regularly visit a primary care provider for common childhood illnesses, periodic physical exams, and immunizations to meet state requirements for school attendance. However, there are no requirements to visit a mental health professional. Government-subsidized health insurance provides children coverage for preventive, and other healthcare services, if they are not easily accessible. The number of mental health professionals who are qualified to treat children is substantially low, while the number of children with mental health/behavioral disorders is constantly increasing.
A guide to treatment
I recently co-edited the book, Child and Adolescent Behavioral Health: A Resource for Advanced Practice Psychiatric and Primary Care Practitioners in Nursing3 with two colleagues: Drs. Edilma Yearwood and Geraldine Pearson. They are both board-certified, child and adolescent psychiatric health clinical nurse specialists (CNS). The concept driving the book was a focus on the integration of behavioral health and primary care for advanced practice nurses in medical and psychiatric practice.
Dr. Pearson's article in this issue, “A child with undiagnosed ADHD” on page 6, describes a case study of a child with ADHD and the challenges that can sometimes arise when working with parents to devise the best treatment strategy.
All persons who interact with children should be educated to recognize the signs and symptoms of behavioral and mental disorders. A few organizations who have experience with these types of disorders are: The National Association of Pediatric Nurse Practitioners, International Society of Psychiatric Mental Health Nurses, American Academy of Pediatrics, NAMI, and The National Institute of Mental Health. Preventing long-term disability and fostering health development in our children is a top priority.
Jamesetta Newland, PhD, RN, FNP-BC, FAANP, FNAP
1. Newland J.NPs a ray of hope for the mentally ill. Nurse Pract. 2006;31(11):6.
3. Yearwood EL, Pearson GS, Newland JA eds.Child and adolescent behavioral health: A resource for advanced practice psychiatric and primary care practitioners in nursing
. West Sussex, UK: Wiley-Blackwell; 2012.