Group tackles child mental health

The state's largest health foundation is teaming up with local organizations to improve mental health care for New Hampshire's children.

The Concord-based Endowment for Health announced yesterday that it was embarking on a five-year project with several organizations to focus on three areas: integrating children's mental health care in schools and primary care settings, promoting research-based treatment and interventions, and advocacy.

"Our mental health care system for children is seriously challenged," said Kim Firth, program director for the Endowment for Health.

"The endowment has an obligation to invest our resources in improving the existing delivery system for mental health," she said.

Firth said the project will be a five-year multimillion-dollar affair, but she declined to give a specific price tag, saying the figure is in flux and depends on the types of grant proposals it receives.

Researchers and endowment officials noted that mental health centers are underfunded, one in five children have been diagnosed with a mental health disorder and New Hampshire faces a shortage of child psychiatrists. With only 32 practicing in the state, that translates to less than one child psychiatrist for every 10,000 children.

"If we know that 20 percent of the population has a mental illness, that is probably too few," said Steve Norton, the director of the New Hampshire Center for Public Policy studies, which examined the prevalence of mental health problems among children, the cost of care and the status of services in the state in three reports commissioned by the endowment.

According to those reports, almost 56,000 children between 5 and 19 suffer from a mental health disorder, depression being No. 1, and nearly 14,000 of 9- to 17-year-olds suffer from emotional problems. In 2005, 25 percent of children on Medicaid and 12 percent of privately insured children were treated for mental illness. That disparity "raises important questions about the differences in how these populations are served," the report's authors concluded. It also is pricey - the cost for mental health care for children on Medicaid was $81 million - more than half of the total medical expenditures for children.

Researchers said New Hampshire has a higher-than-average number of family physicians and pediatricians, the major prescribers of psychiatric medication for children. Overall, however, "when you look at all the primary providers of mental health prescriptions to children - psychiatrists, family practitioners and pediatricians - New Hampshire ranks the lowest in Northern New England," researchers Norton, Ryan Tappin and Laura McGlashan wrote.

The shortage is most acute in the North Country. Carroll and Coos counties have no child psychiatrists. They also have the fewest psychologists, at 9 and 4 each, respectively. Both counties fall below the state average of more than three psychologists per 10,000 children. In Carroll County that figure is two per 10,000 children. In Coos County, it is one per 10,000. New Hampshire's 210 school psychologists also are spread unevenly across the state, with far more employed in high-population counties in southern New Hampshire.

"When you throw this information onto a map about the workforce, what you discover is that as you drive north on (Interstate) 93 you get farther and farther away from an adequate supply of mental health providers," Norton said. "And when you go through the (Franconia) Notch, you basically get to an area where it's virtually impossible for a child who has a serious mental illness to get access to services, or at least access to a child psychiatrist."

Increasing teleconferencing for training, treatment and supervision in the North Country could help alleviate the shortage, Norton suggested. (next page »)