Congress should apply a key lesson from the War on Cancer to address pediatric behavioral, mental health crisis
The COVID-19 pandemic has sparked an explosive increase in behavioral and mental health disorders among children and adolescents. What was once a widespread and worsening problem is now a crisis.
The National Institute of Mental Health has estimated that nearly half of U.S. adolescents ages 13-18 will have at least one behavioral / mental disorder in their lifetime, with nearly a quarter having severe impairment. One in five children have experienced a psychiatric disorder within the past year. Fewer than half of young people with these disorders receive treatment, and for those receiving treatment, the average delay between symptom onset and treatment initiation is 10 years. The impact among youth from communities of color is even worse.
Untreated child and adolescent psychiatric disorders can persist over decades, becoming increasingly difficult to treat and resulting in progressively greater family, social, educational and economic consequences.
The American Academy of Pediatrics, the American Academy of Child & Adolescent Psychiatry and the Children’s Hospital Association have all declared pediatric behavioral and mental health a health care emergency.
Fifty years ago, our nation faced a similar challenge, with a long-standing health concern that had become a crisis. The crisis was cancer; a diagnosis was often a death sentence. In 1971 the National Cancer Act was signed into law and the War on Cancer was launched.
In a recent New England Journal of Medicine article, four of the nation’s leading oncologists described the progress made since the signing of the Act and the strengthening of the National Cancer Institute as “remarkable.” The authors credit much of this progress to increased research funding.
Congress responded then with a comprehensive, coordinated national plan that aggressively and effectively addressed the crisis. It must do the same with today’s pediatric behavioral and mental health crisis.
Despite the high prevalence of behavioral and mental health disorders among young people, the underlying causes are still poorly understood. Using increasingly sophisticated methodologies, such as genetic sequencing and neuroimaging, researchers are investigating the most complicated and debilitating behavioral and mental health conditions, including anxiety, depression, psychosis, autism and addiction.
These researchers are seeking to fundamentally transform our understanding of pediatric behavioral and mental health conditions and in turn create new, more effective therapies and standards of clinical care.
To succeed, Congress should apply a key lesson from the War on Cancer, by creating and funding a national research effort equal to the scale of the crisis. Over the next five years Congress must double federal pediatric behavioral and mental health research funding. Doing so would enable us to better understand and more effectively address a crisis that is impacting millions of young people, and is growing more menacing and harmful every day. In addition, the National Institutes of Health should track how much of its funding for behavioral and mental health research is allocated to pediatric research to establish a baseline and measure progress.
We must also transform our nation’s fragmented and inadequate pediatric behavioral and mental health infrastructure. The pandemic has exposed its extensive shortcomings and highlighted the need for immediate action to increase capacity, expand access and improve prevention.
Many children’s hospitals today are reporting more than twice as many patients with psychiatric diagnoses requiring hospitalization than there are psychiatric beds, and the time those patients are staying in the hospital has doubled from pre-pandemic days.
In addition, there is a shortage of child and adolescent psychiatrists, psychologists, developmental pediatricians, psychiatric nurses, psychiatric social workers and other specialists.
This is why we support the bipartisan legislation introduced recently in Congress by Reps. Anna Eshoo (D-Calif.), Brian Fitzpatrick (R-Pa.) and Lisa Blunt Rochester (D-Del.) that addresses the urgent infrastructure aspects of the crisis. The Strengthen Kids’ Mental Health Now Act (H.R. 7236) would repair the pediatric health care safety net, improve access to behavioral and mental health care through better integration and coordination, rebuild our pediatric behavioral and mental health treatment system, support workforce development, and promote health equity by addressing the social determinants contributing to health care disparities.
Congress should approve this much-needed legislation, and President Biden should sign it into law.
The time to act is now. The pediatric behavioral and mental health crisis can no longer be ignored and underfunded. Failure to act will have devastating and long-lasting consequences, not only for our children, but for all of us.
Kevin B. Churchwell, MD, is president and CEO of Boston Children’s Hospital; Paul A. King is president and CEO of Stanford Children’s Health.
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