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Perrin: Promotion of Mental Health as a Key Element of Pediatric Care


Numerous national surveys, cohort studies, and meta-analyses have documented the etiologic and experiential connections between childhood abuse, physical illness, and mental health disorders1,2 spanning from childhood to adulthood. Yet pediatric training and practice typically focus primarily on the identification and treatment of physical health conditions. The recent advent of enthusiasm for integrated care is a welcome nod to the marked comorbidities that have been amply reported.

Approximately 20% of children and adolescents have a diagnosed mental health or behavioral disorder that threatens their development and well-being3 and often foretells adult mental health disorders.4 In addition, many children have symptoms of mental health or behavioral disorders that do not meet diagnostic criteria but nevertheless carry significant risk of impaired adult functioning. Children who have had adverse experiences of various types are at greater risk of developing both physical and mental health or behavioral problems during childhood, adolescence, and adulthood.

In the face of this immense, important, and growing need, there is a severe shortage of qualified mental health clinicians across the countryโ€”a deficiency that is especially acute for (but not limited to) children younger than 13 years and children of nonwhite racial/ethnic backgrounds or limited financial means. Access to and use of mental health services by parents and children is limited by stigma, geography, financial constraints, and the paucity of qualified clinicians. The lack of access to behavioral health services has been called a national emergency, especially highlighted by the striking increase in the number of adolescents with serious depression and suicide, which is now the second leading cause of death among individuals aged 10 to 34 years. The urgency of addressing mental health and behavioral disorders in childhood is highlighted by the fact that most such disorders diagnosed among adults had their origin and early symptoms in childhood.

Furthermore, children with chronic physical health conditions have a heightened risk of mental health symptoms and disorders,5 and children with mental health and behavioral disorders are at an increased risk of diabetes, heart disease, and inflammatory diseases.6,7 Nevertheless, the service systems remain remarkably separate.

Pediatricians in primary care practices and across specialties are increasingly called upon to develop mechanisms to promote well-being, prevent mental health disorders, identify children at risk as early as possible through regular screening, and provide a mechanism to ameliorate at least the most common mental health and behavioral disorders. These responsibilities are too important and too complex to be successfully accomplished by pediatricians alone. Primary care and subspecialty pediatricians are increasingly creating teams to supplement their activities. These teams may include a case worker who helps families to address social determinants of health, a nurse to supervise the care of children with a chronic physical illness, and a mental health clinician to focus on the critical tasks necessary to promote the resilience and mental health of their patients.

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