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Program aims to provide better adolescent psychiatric care

Monday, November 17, 2008 | 5:22 p.m. CST

COLUMBIA — If you live in the United States and your child develops a mental illness, finding an adolescent psychiatrist may be difficult.

A 2006 report by the American Association of Child and Adolescent Psychiatry estimated that of the approximately 13.7 million children needing treatment, less than 20 percent actually receive it. While barriers in insurance coverage and the stigma associated with mental illness are seen as factors for the inadequate amount of treatment, many within the field cite the lack of providers as the primary cause.

A new certification program between the MU College of Education and School of Nursing aims to improve the state of child psychiatry by training nurses, teachers and other education providers in adolescent mental health.

The goal is that by training more professionals in the field, the burden of care will not be solely on psychiatrists. In smaller cities, such as Columbia, finding a child psychiatrist can be especially difficult.

“There’s not proper geographic distribution. The majority of psychiatrists provide care in metro areas. Very few go into rural areas,” child psychiatrist Syed Arshad Husain said.

“The pay for psychiatrists in Boone County is a lot lower than it is nationwide. Attracting capable people is getting to be almost impossible,” Jerry Olson, co-chair of the Boone County Mental Health Board, said.

Husain states that there simply aren’t enough psychiatrists going into the field.

“Child psychiatry is too long a program. It’s very costly to become a psychiatrist and people don’t want to prolong their training,” Husain said.

A 1990 report from the Council on Graduate Medical Education said there would be a need for more than 30,000 adolescent psychiatrists. The 2006 report from the American Academy of Child and Adolescent Psychiatry said there are about 7,000 adolescent psychiatrists practicing today.

Laine Young-Walker, associate medical director for the Missouri Department of Mental Health, believes the problem is that there simply aren’t enough child psychiatry programs available. There are currently 122 adolescent psychiatry programs in the U.S., and according to the American Association of Child and Adolescent Psychiatry, only 300 adolescent psychiatrists complete training each year.

Young-Walker said there has been some discussion nationwide about training primary care physicians and pediatricians in psychiatry.

While the professionals trained in the MU College of Education and School of Nursing's new certification program will not replace psychiatrists, they could help alleviate problems in smaller communities where primary care physicians are often the only ones available to provide psychiatric care. The program will begin in January, with funding coming from a $370,000 grant from the Health Resources and Services Administration.

Jim Koller, founder and co-director of the MU Center for the Advancement of Mental Health Practices in Schools, says this will allow for a more proactive approach to mental health care.

“The wait-to-fail model we’ve been using in the U.S. isn’t going to work,” Koller said. “The training for teachers will show them how to recognize early signs of mental illness and how to nourish good mental health.”

Olsen believes detecting mental illness early is key, “because if nothing's done they’ll probably end up on the streets or in jail.”

Koller also emphasized the importance of training school nurses, coaches and other employees. The center hosted workshop institutes around mid-Missouri over the summer, offering courses in mental health to families and school employees.

“If a kid's going to commit suicide, is he going to go tell the counselor? No, probably not. He’s going to go tell the coach or the cafeteria worker who gives them a little extra ice cream at lunch,” Koller said.

The nursing program will be the addition of courses dealing with mental health assessment and treatment options for children to the already existing adult mental health nurse practitioner program. The program will also be offered online.

“People who are in the program don’t have to leave their community to get their  education. So they’re staying in rural areas, and when they graduate they’ll be able to continue in their communities with improved skills,” said Jane Bostick, associate professor of nursing at MU.

Koller said that one of the goals of partnering the two schools is getting the various professions to work together.

“Right now everyone’s kind of in silos. We need people to better understand each other’s roles and reach across,” Koller said.


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