Download Here`s

When Children Have a Mental Illness
By Anne Chappell Belden
How Parents Cope with a Lack of Support, Insurance and Understanding
*Names of the children who have struggled with mental health issues and their
parents who we interviewed for this article have been changed to protect the
families’ privacy.
Samantha Waters’* son Brad was in third grade when he first told her that he
wanted to die. He said he was going to get up in the middle of the night and stab
a knife through his heart.
“It was so out of the blue,” says Waters. “He acted so normal, like he was always
having a good time.”
Waters notified the school and took Brad to a therapist; he seemed to improve.
But in sixth grade, with the added social and academic pressures of middle
school, Brad’s talk of dying intensified. Though he was a smart kid with plenty of
friends, he told his mother that he was stupid, worthless and didn’t like himself.
Usually, the episodes came at night. Waters tried to protect her son by watching
him around the clock. At one point, she slept on his bedroom floor. “I would
watch him breathe all night,” she says.
“The worst was when he was asking, begging, pleading, demanding for me to kill
him. I told him, ‘No, I can’t do that. I love you too much.’ He wouldn’t even believe
that I loved him.”
A psychiatrist diagnosed Brad with depression stemming from a chemical
imbalance. The diagnosis and subsequent treatment is not unusual for a child. In
fact, an estimated one in 10 children and adolescents in the United States suffers
from a mental illness severe enough to significantly interfere with daily life.
Cases of depression, bipolar disorder and anxiety disorders are increasingly
common in kids, according to mental health experts. It’s not clear whether more
children are actually suffering from mental illness, whether improved diagnosis
and parental awareness have resulted in more cases, or both. One thing is
certain, however. As mentally ill children and their families seek help, they must
wade through a mental health system that is “in shambles,” according to a 2003
presidential commission. Now, two years later, the system isn’t much better.
Among the biggest problems:
• Mental health services are fragmented, made up of a “patchwork” of disjointed
institutions and inconsistent laws.
• A shortage of care facilities and child and adolescent psychiatrists makes
finding qualified help difficult. While estimates put the number of mentally ill
children in the United States at 6 million, there are only about 7,400 child and
adolescent psychiatrists. Rural areas are particularly hard hit by this shortage.
• Mental illness generally does not get the same health insurance coverage as
physical illness. Parents of mentally ill children often pay out-of-pocket for
services their kids desperately need.
It isn’t that people aren’t paying attention. Children’s mental health problems are
acknowledged by some pretty heavy-hitters:
“The burden of suffering by children with mental health needs and their families
has created a health crisis in this country,” former U.S. Surgeon General David
Satcher reported in his 2001 National Action Agenda on Children’s Mental
Health.
“Every child deserves a good start in life,” says former First Lady Rosalynn
Carter, founder of The Carter Center Mental Health Program, which aims to raise
awareness and reduce the stigma of mental health, make mental health care
equitable with other health care and help foster prevention and early intervention
services for kids and their families.
“We know so much more about the brain and effective treatments than we did
even a decade ago,” Carter says. “There is mounting evidence that the trajectory
of a child’s life can be altered considerably in a positive way when treatment is
provided as early as possible.”
Yet, about 70 percent of children with mental illness go untreated, she says, and
their futures are uncertain. Mentally ill children have much higher rates of school
failure, family conflicts, drug abuse, violence and suicide.
Children and teens who do receive treatment often endure incorrect diagnoses
and numerous changes in medication and therapists. Complicating treatment
further, last fall the U.S. Food and Drug Administration issued a “black box”
warning (the agency’s most serious labeling of a medicine and its potential risks)
that antidepressants could cause suicidal thoughts and behaviors in teens.
Could Your Child Have a Mental Illness?
Every child is sad, fearful, anxious or moody some of the time. How can parents
differentiate between what’s normal and what could actually be a mental
disorder?
Child psychiatrists advise parents to look for a pattern of behavior. A child who is
often irritable or sad – not just after a loss or sad event – may be clinically
depressed. A child who is often anxious or worries so much that it interferes with
daily life may have an anxiety disorder. And a child whose moods swing to
extremes – from elation to depression – could be bipolar.
But diagnosing mental illnesses in children can be difficult; symptoms and even
disorders can overlap, child psychiatrists say. Here’s a closer look at the mental
disorders commonly seen in children today:
Anxiety Disorders – The most common of the mental, emotional and behavioral
problems in children. They include separation anxiety, generalized anxiety and
social phobias. About 13 out of every 100 children and adolescents, ages 9 to
17, experience some kind of anxiety disorder, with girls more affected than boys,
according to the surgeon general’s 2001 report.
• Separation Anxiety Disorder – Most kids show normal signs of separation
anxiety, such as when their parents leave or when children start a new school.
For about one in 25 children, however, separation anxiety becomes a disorder
when the parents can’t leave, says Shannon Barnett, M.D., an assistant
professor of child and adolescent psychiatry at Johns Hopkins University.
“The parents are really held hostage by the illness. They can’t go to the
bathroom; the child follows them. They can’t get them to school; the kids will
complain of stomachaches so they can call home,” Barnett says. “Those kids
won’t go to a friend’s house or play sports because they can’t be separated from
their parents even to do fun things.”
• Generalized Anxiety Disorder (GAD) – Typically occurs between ages 10 and
12. Kids with GAD worry about everything: finances, schoolwork (even if they are
getting A’s), storms and natural disasters. “If they see a storm on the news, they
think about it for a long period of time,” Barnett says.
• Social Phobias – As children become teenagers, social phobias tend to strike
those who may be shy or have low self-esteem. These teens often cannot eat in
front of others, do presentations in class or change clothes for gym in front of
others.
“They are really worried about what other people think. They don’t want to go to a
party or the mall, things other teens do,” Barnett says. “They are so sure people
are thinking bad things about them.”
• Obsessive-Compulsive Disorder (OCD) – A combination of intrusive thoughts
and compulsive behaviors. Kids may become obsessive about germs or
neatness, and do compulsive acts, such as repeated counting, hand-washing or
checking over and over again to see if a door is closed.
Donna Wilde’s* son Anthony was a shy freshman in high school and having a
rough time socially when he began to wash his hands for up to a half-hour at a
time and take 40-minute showers. In his sophomore year, he made a few friends,
and his symptoms seemed to diminish. But then Wilde uprooted Anthony and
moved out of state.
“That seemed to be the downfall, what he couldn’t get past,” she says. Not only
did his OCD symptoms increase, Anthony grew depressed. “He didn’t leave his
room,” Wilde says. Therapy and four different medications have not yet helped
his OCD, but his depression has improved.
About half of children and adolescents with anxiety disorders have a second
mental disorder, such as depression.
Depression – An estimated 3.4 million American children and adolescents have
clinical depression, and those numbers are on the rise, says child psychiatrist
Graham Emslie, M.D. Emslie, an internationally known researcher on the use of
medicine and psychotherapy for children and adolescents with depression,
attributes the increase to two factors:
• kids live with more stress and less extended family support today, and
• they are starting to suffer from depression at younger ages.
Depression also has a genetic component; about half of the children diagnosed
have a parent or sibling with the illness. Most at risk for depression are kids who
are abused, neglected or experience traumas such as divorce or loss.
Depression rates increase in adolescence, with one out of eight teens affected.
Until adolescence, boys and girls have equal rates of depression. After middle
school, however, the rate doubles for girls. But, while five teenage girls attempt
suicide for every one boy who tries, five boys actually succeed in killing
themselves for every one girl who does, Emslie says.
Along with signs of persistent sadness and irritability, parents should also be
concerned if their child’s grades start to fall, or if she has trouble concentrating or
withdraws from friends or activities. Changes in eating or sleeping and talk of
death or suicide are also indicators, Barnett says.
Brad Waters’ talk of suicide turned into action in sixth grade. One day after a bike
ride, he rushed inside, climbed up on the kitchen counter and grabbed a knife
from the cupboard. His sister was the first to notice.
“‘Mom, he’s got a knife,’ she said. So I went over there and had to pull it out of
his hands,” his mother recalls. Brad said he acted out because he wanted to
change his medication.
Heartbreak caused Brad to battle depression again in seventh grade. “He takes
rejection very personally. He’ll think about it so hard and deep, as sad as sad can
go. Or as destructive,” his mom says. “It’s self-mutilation of the mind.”
Now 13 and in eighth grade, Brad ran away in September for about five hours
after a confrontational therapy session. Just before Thanksgiving, he was
admitted to the hospital after taking four days’ dosage of his medication all at
once. He told his mother he wanted to die, and if the extra medication didn’t kill
him, at least it might make him happy.
_______________
Bipolar (Manic-Depressive) Disorder – Cases in children have increased
dramatically in the past decade, primarily because doctors previously didn’t think
this largely hereditary disorder affected kids. Bipolar kids were often
misdiagnosed with attention deficit/hyperactivity disorder (AD/HD).
As with depression, bipolar children experience extreme sadness, irritability and
hopelessness. But their moods also swing to extreme elation, silliness and
hyperactivity. Minor incidences can set off big reactions that take a long time for
them to recover from, Barnett says.
Sharon Goldstein* and Ruth Wood* have witnessed hundreds of severe mood
swings over the years with their son, Max, who showed symptoms of bipolar
disorder even as a toddler. “If he played in the sandbox, he might play nice for 15
minutes and then pick up the toy truck and slam it over the head of another kid,”
Goldstein says. “Other kids might do that once. We experienced it 100 percent of
the time. He couldn’t be in a play group.”
Nor could he be left alone at any moment, even when he slept. During naptimes,
Max would take his diaper off and spread feces on the wall. “That’s something
other kids will do once or twice. Max did it a couple times a week for a year,”
Goldstein says.
The illness was worse at night, when night terrors invaded Max’s sleep.
Goldstein says when most people dream, they wake up before something terrible
happens, like being attacked by a bear or falling off a cliff. Max’s brain, however,
doesn’t wake him up. “So he experiences being eaten and going off a cliff.”
Goldstein and Wood first took Max to a therapist after his preschool teacher said
he was taking too much attention. The therapist said there was nothing wrong.
Yet Max, at age 3 or 4, told his parents he wanted to die. “He was suicidal before
he knew what suicide was,” Goldstein says.
When he started kindergarten, Max ended up in the principal’s office daily. He hit
other children, talked back to the teacher and couldn’t sit still. Six weeks into the
school year, Goldstein and Wood pulled Max out of school after they witnessed
him yanking out his hair.
Goldstein spent 10 to 12 hours on the phone getting referrals for the best
therapist, who diagnosed Max as severely bipolar. He was 5. “That was the first
validation we had that something was wrong,” she says.
Over the years, they’ve endured bad therapists, lost friends and relatives who
assumed they were terrible parents, felt ashamed and tried to hide Max’s illness.
On a typical day, after playing nicely for half an hour, Max might start hitting
Goldstein, throwing things at her, and pulling out her earrings.
“I think he’s broken 10 pairs of glasses,” she says. She would hold him until he
cried and fell asleep. “Then I would cry,” she says.
Wood and Goldstein have learned to handle Max’s mental illness by keeping him
on a rigid schedule. “We can’t let him get tired. We can’t let him get hungry,”
Goldstein says.
Eventually, their “bad parenting” shame was overruled by psychiatrists and
therapists who praised their parenting skills.
Over the years, Max has tried 30 to 35 different combinations of medicines –
each change difficult and disruptive. They’ve tried holistic methods, diets and
vitamins, and have taken Max to more than a dozen therapists and psychiatrists.
“He has made significant progress,” Goldstein says. “He has worked so hard to
be in a normal range of behavior.”
The family has spent $10,000 a year on medication and doctors’ bills. Despite
recent improvements in coverage, their insurance pays just one-third of the $150per-visit bill.
A Broken System
Max’s family’s struggle illustrates the fractured mental health system that
frustrates parents seeking help.
Access to care is perhaps the greatest problem, says Alvin Poussaint, M.D., a
noted professor of psychiatry at Harvard University. Many inpatient and
outpatient services for children have closed due to financial hardship, in part
because children often need more comprehensive – and expensive – care, with
someone working with parents and the school. Meanwhile, any insurance
reimbursements are often small.
“It’s not a money-making operation. It costs to treat children properly and
comprehensively,” Poussaint says. “You can’t just bring them in and do one-onone therapy and send them out.”
The shortage of child psychiatrists makes matters worse, he adds. “They are in
demand all over. Most are too busy to provide additional services.”
Adding to the strain are inequities in insurance coverage. “It’s much harder to
collect from the insurance companies for mental health,” Poussaint says. “The
big problem is reimbursing at an adequate rate.”
Services for children need to be publicly subsidized or else the insurance
industry must be made more responsive to mental health needs, he says.
But Blue Cross spokesman Michael Chee disagrees and says the issue is
extremely complex. Most Americans with health insurance receive it through their
employers, and it’s the employers who make the choices, he says. “The people
who pay the bill are the people who get to choose what is covered or not
covered.”
For people who pay for their own insurance, policies vary dramatically from state
to state depending on the insurance company, local market conditions and state
regulations and laws, Chee says.
At least 33 states have a mental health parity law requiring insurance policies to
carry a minimum defined level of mental health benefits. Legislation before
Congress, the Senator Paul Wellstone Mental Health Equitable Treatment Act,
would require insurance companies to provide coverage for mental illnesses
equal to that for other illnesses.
“Passing this legislation would prevent more suffering than anything else we
could possibly do,” former First Lady Carter says. “I also believe it would help
overcome the stigma.”
Even if such legislation passes, Chee says the real problem is there are so few
facilities and child psychiatrists, it is difficult for insurance companies to get
contracts with them. “In certain areas, there may not be any to contract with,” he
says.
Though the Waters live in a city with more than one million people, the nearest
psychiatric hospitals that treat children are an hour or more away. But Samantha
Waters considers her family fortunate. Her health insurance plan paid for four
hospital visits, including ambulance rides, medication (eight changes so far) and
hundreds of hours of therapy, with only $10 co-pays.
Advice from the Trenches
The parents and experts we interviewed agree that getting the best help – which
may entail multiple referrals and meetings with several professionals – is critical.
Parents say they’ve also needed their own therapy to learn to cope.
Rosalynn Carter says parents should become informed about advances in
treatment.
“Mental illnesses can be diagnosed, effective treatments are available, and
recovery is possible,” she says. “There’s no question, though, that accessing
appropriate treatments can be challenging – but don’t give up! Parents must
become advocates for their children.”
For Waters, the lessons boil down to love. “If I could have taught my son selflove, I think I could have prevented a whole lot,” she says.
_______________
Indeed, Brad’s depression has taken a toll on the whole family. Waters finds
herself depressed after each episode and she and her husband have sought
counseling to learn how to co-parent better.
Brad’s younger sister has also suffered. She is terrified that her brother’s going to
die, and has been “almost neglected” at times, her mother says.
Brad now takes Prozac and attends group and individual therapy sessions each
week. His doctors say the medication will help his brain develop healthy thought
patterns.
In the meantime, his mother tries to cope as best she can. “I try to give him love
and support every day,” she says. Yet every day, she must live with her greatest
fear, “that he’ll get brave enough to do it.”
Related Reading:
Common Mental Disorders in Children: Find out about the symptoms,
treatment options and recent research findings for anxiety disorders, depression,
and bipolar disorder.
Are Antidepressants Safe?
Mental Health Resources: Organizations and Reading
Anne Chappell Belden is a journalism instructor and award-winning freelance
writer.
From United Parenting Publications, March 2005