New federal legislation aims to increase the number of pediatric mental
health clinicians by cutting their "overwhelming educational debt"
through loan repayments, grants, and scholarships.
The Child Health Care Crisis Relief Act (HR 1932), introduced by Rep.
Patrick Kennedy (D-R.I.) on April 2, would ameliorate the shortage of
psychiatrists and mental health professionals trained to treat children and
adolescents by reducing financial barriers that may lead medical students to
higher-paying areas of medicine.
"This bill will greatly alleviate the paucity of available
specialists trained in child and adolescent psychiatry," said Robert
Hendren, D.O., president of the American Academy of Child and Adolescent
Psychiatry (AACAP), in a written statement. "Enacting this legislation
will allow child and adolescent psychiatrists to receive federal support to
complete their training by removing a considerable financial
The legislation would authorize medical school loan repayment programs,
scholarships, clinical training grants, and education grants for children's
mental health professionals including child and adolescent psychiatrists,
behavioral pediatricians, child psychologists, school psychologists, school
social workers, school counselors, psychiatric nurses, and marriage and family
therapists. The bill includes grants to graduate schools to help them launch
and expand child and adolescent mental health education programs.
Child and adolescent psychiatry, Hendren noted, is the only medical
specialty that provides comprehensive training to physicians to assess and
treat children and adolescents' mental illnesses. However, efforts to increase
the numbers of such specialists have been thwarted by "overwhelming
educational debt" as well as pressure and incentives for medical
students to pursue careers in primary care. Additional disincentives for
students considering child and adolescent psychiatry include a long training
period and insurance-reimbursement problems, according to a 2008 AACAP
The shortage of U.S. child and adolescent psychiatrists, according to
AACAP, has reached a "crisis level," with approximately 7,000
practicing in a country with about 73 million children and adolescents. On
average only 300 specialists complete training each year. The number of child
psychiatrists is insufficient to meet the demand for their care, when more
than 13.7 million children and adolescents are in need of treatment for mental
disorders, but only 20 percent of them receive adequate treatment, according
to a 1999 U.S. surgeon general's report.
"Part of the reason for this alarming statistic is that mental health
services specific to children are in very short supply," Kennedy
Kennedy said his legislation stems from frustrated pediatricians repeatedly
telling him that they cannot find available professionals for their patients
who need mental health evaluations. Another factor that spurred the bill,
Kennedy noted, was that large numbers of parents are unable to find or afford
timely mental health care for their children. This predicament has led a
growing number of parents to relinquish custody to the state, which is
mandated to provide psychiatric care for its wards.
"This legislation seeks to increase the number of child mental health
care professionals so that we can diagnose the problem early on and treat
it," said Rep. Ileana Ros-Lehtinen (R-Fla.), a cosponsor of the bill, in
a written statement.
Kennedy said in a House floor speech that the bill is aimed not only at
providing incentives for health care workers to choose mental health careers,
but also at expanding treatment options for children.
The 2003 report of the President's New Freedom Commission on Mental Health
found that most children and adolescents who receive treatment for psychiatric
illnesses obtain it from their primary care physicians—who identify
about 19 percent of their young patients as having a mental disorder. However,
children with serious and persistent mental illness who do not improve with
initial intervention from a primary care clinician may require the specialized
treatment of a child and adolescent psychiatrist, according to AACAP.
The commission also found that children and adolescents who need mental
illness treatment and do not receive it are at a higher risk for school
failure, problems at home, substance abuse, and entrance into the
The Child Health Care Crisis Relief Act can be accessed at<http://thomas.loc.gov>
by searching on the bill number, HR 1932. ▪