Into the minds of children - Boston Globe

December 28, 2007

EDITORIAL

CHILDREN with undiagnosed mental illness can be a harm to themselves, their families, and their schoolmates. The conditions often go undetected because parents, while sensing that something is wrong, do not press the issue with their pediatricians, who themselves are often too busy to ask the right questions. So by requiring that pediatricians treating Medicaid patients screen for common mental illnesses, Massachusetts is taking a major step forward in promoting children's mental health.

For young children, parents will be asked, but not required, to fill out questionnaires asking about sleep problems, failure to show emotion, difficulties in concentrating, and other possible symptoms of underlying conditions. Adolescents will supply the answers themselves. It will be up to the families to decide whether to pursue any recommended course of treatment.

The screening, for which pediatricians already receive reimbursement from most private insurers, will benefit both the children who get timely attention and society as a whole. Early detection of bipolar disorder, autism, or depression can lead to effective treatment that will avoid costly periods of institutionalization if the condition is left unattended. Screening also helps to take away the stigma that many people still attach to mental illness, and to create data to measure the prevalence of disorders.

There are legitimate concerns that the screening will increase caregivers' caseloads and add to the difficulties parents already experience in getting care for troubled children. One solution is the state's Child Psychiatry Access Project, in which pediatricians seeking advice by telephone from a child psychiatrist get a response within 30 minutes.

The screening will not serve its purpose if it simply becomes a pipeline to the powerful psychotropic drugs that some experts believe are used too heavily with children. More likely, though, the screening will help to galvanize children's best advocates, their parents, in pushing for more care for them from the healthcare system and their schools.

Sometimes it takes more than just one screening result to get a parent to follow up on a child's evident needs. "Some parents have to hear things three or four times," said Lisa Lambert of the Parent/Professional Advocacy League. But eventually a long-term source of frustration with a child can become a diagnosis. "With the diagnosis," Lambert said, "doors and services can open to you."

Opening doors and services for the mental-health needs of the state's poor was the goal of the federal court case Rosie D. v. Romney, which is resulting in several systemic changes. Medicaid screening is the most basic. It will make Massachusetts a leader in ensuring that children's mental disorders get the same attention as any physical ailment.