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Article Excerpt
Mental health problems among children have been described as a public health crisis as a direct result of the troubling, and oftentimes tragic, impact mental health disorders have on the lives of children and families (U.S. Public Health Service [USPHS], 2000, p. 5). After the publication of Unclaimed Children: The Failure of Public Responsibility to Children and Adolescents in Need of Mental Health Services (Knitzer, 1982), national attention began to be focused on problems in the children's mental health system (see Tolan & Dodge (2005). Despite this attention, however, there has been little progress in improving mental health service delivery; as a result, many children continue to receive inadequate care for mental health concerns (Tolan & Dodge, 2005). In a report from the Surgeon General's Conference on Children's Mental Health (USPHS, 2000), former Surgeon General David Satcher stated,
Growing numbers of children are suffering needlessly because their emotional, behavioral, and developmental needs are not being met by those very institutions which were explicitly created to take care of them. It is time that we as a Nation took seriously the task of preventing mental health problems and treating mental illnesses in youth. (p. 5)
As one of the disciplines with direct influence on children's mental health, the counseling profession has the potential to have a significant role in improving services and outcomes for children and their families. Given the promise to improve mental health services and outcomes, this article examines emerging trends, national initiatives, and current activities focused on the children's mental health system. The responsibilities of counselors in children's mental health are also described. Finally, suggestions are made for the role of counseling professionals in terms of counseling practice, training, leadership, and research.
* Emerging Trends in Children's Mental Health
One in 5 children has a diagnosable mental health or addictive disorder, and 1 in 10 has a serious emotional disturbance that significantly impairs functioning at school, at home, and in the community (U.S. Department of Health and Human Services [USDHHS], 1999). Disruptive behavior disorders (31%), mood disorders (21%), and adjustment disorders (16%) are the most frequent diagnoses among children, and almost 40% of children and adolescents with mental health diagnoses are considered seriously emotionally disturbed (Pottick, 2002). Estimates also indicate that 1 out of every 10 male children between the ages of 3 and 17 is diagnosed with attention deficit hyperactivity disorder (ADHD; Child Trends Data Bank, 2005). Of growing concern are the large numbers of children who are likely diagnosed with two or more mental health problems. Among older children (ages 13-17 years), 32% are likely to have cooccurring diagnoses, most often ADHD and mood disorders (Warner & Pottick, 2004).
Despite the large number of children and their families who are struggling with mental health concerns, estimates suggest 70% will receive no mental health care (USDHHS, 1999). Further complicating discussions of treatment for children is the reality that children with mental health problems are involved with multiple systems (USDHHS, 1999). Schools, primary care physicians' offices, child welfare programs, and juvenile justice courtrooms represent a few of the settings in which children receive mental health intervention even if these entities are not funded or equipped to provide this type of care (Huang, Macbeth, Dodge, & Jacobstein, 2004). Citing a previous study by Burnes et al., the USDHHS (1999) indicated that among children with mental health concerns who do receive services, 40% receive specialty services provided through the mental health sector, 70% are served by schools, 16% by child welfare, 11% by health care providers, and 4% receive services in the juvenile justice system.
In addition to problems coordinating mental health care across multiple systems, there are also increasing trends for using psychotropic medications with children. Some experts have suggested that increases in drug treatment for children's mental health concerns is a direct result of community-based mental health professionals who are ill-equipped to treat children and their families (Levin-Epstein, 2006). Olfson, Blanco, Linxu, Carmen, and Gonzalo's study (as cited in Levin-Epstein, 2006) found that antipsychotic medications are prescribed for children at 6 times the rate they were a decade ago (i.e., 1.2 million...
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