Issue link: https://tmcpulse.uberflip.com/i/515661
t m c » p u l s e | m a y 2 0 1 5 9 The thing is, when you talk to an adult about their mental health problems, regardless of what it is, and you ask them when their symptoms began, the vast majority will tell you that their symptoms started in childhood. It's not like you turn 18 and suddenly you have mental health problems. — LAUREL WILLIAMS, D.O. Director of the Baylor Child & Adolescent Psychiatry Clinic "Right now, Ben Taub has the capability today to provide appoint- ments within a few weeks or even days at our specialty clinics, our intensive outpatient program and our clinics throughout Houston," explained Shah. "If DSRIP is not renewed, I don't know what would happen to these outpa- tient appointments or these programs, because a lot would need to be cut. If you stop these services all of a sudden, patients will be coming to the emer- gency room again for outpatient care because it's the only place they have to go." What the DSRIP funds have demon- strated is that it is possible to bridge the gap between the emergency room and the months-long waiting lists—as long as resources continue to become available. It's a pervasive problem in the field with wide-ranging conse- quences. Not only could increased funding allow for additional inpatient beds and a broadening of outpatient appointments and programs, but it could also prompt further education in the discipline, which in turn would create more psychiatrists, more practices and more open appointments. "There is a major shortage of psychiatrists and child psychiatrists," said Guerra. "The residency programs are very small and I'm not sure why we are not pushing for this field the way we are for primary care. There is such a huge need for it, especially when you consider that a large percentage of the population at any one time is having some form of mental health issue." Guerra suggested that increasing mid-level providers like nurse practi- tioners and physician assistants would go a long way toward alleviating some of the need. Regrettably, Houston has closed its only psychiatric nurse practi- tioner program. "The program would probably graduate about five to 10 nurse practi- tioners a year, and I guess they felt that it was not viable to keep the program running, but in our community they would be swooped up in two seconds," said Guerra. "I feel like a contribution that Menninger makes is through training social work fellows, social work interns and child psychiatry fellows. On any given day we have a huge number of trainees here on our adolescent unit," Newlin said. "We've expanded Menninger's fellowship program within the past five years and I'm very proud of what we've done with our education and training of child psychiatrists. Many of our fellows are now out in the commu- nity doing really important work." The worth of which cannot be under- stated. While one in five children in the U.S. suffer from a serious mental health disorder at some point in their lives, nearly half—46 percent—will experience some form of mental health issue. In Harris County alone, it is estimated that nine percent of children and adoles- cents will have a severe functional impairment during a given year. Suicide is the second leading cause of death for 15 to 24 year olds in the U.S., kill- ing more teenagers and young adults than cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza and chronic lung disease combined. And here's another statistic: In 2012, Texas ranked 48th in the nation in state mental health expenditures per capita. Although the 2013 legislative session responded by securing record levels of funding, for an issue this prevalent, with consequences as devastating as any disease treated here in the medical center, there is still far too much to be done. Continuing to invest in pediatric mental health will help ensure the children and adolescents in the Greater Houston area have access to the inpa- tient beds, outpatient appointments, Williams voiced the same concern for the lack of providers in the field. "Texas Children's really only has eight child and adolescent psychiatrists on staff, and there are over 1,000 pediatri- cians that can refer to us. There are just not enough of us." Williams added that insurance companies are loath to reimburse forms of psychotherapy, making the field less attractive than others. "As much as there is a problem for parents finding a good psychiatrist, there is equally a problem for finding a therapist that is trained in the specific form of therapy that can help your child." In spite of the shortage, TMC mem- ber institutions continue to emphasize the importance of helping the next generation of mental health clinicians, with many of them expanding their educational missions. "We feel that one of our community responsibilities is not only to train our own staff, but also to provide an exten- sive array of training opportunities for others outside of DePelchin," said Oscar Bukstein, M.D., M.P.H., medi- cal director of DePelchin Children's Center. DePelchin hosts professionals from the Baylor College of Medicine child psychiatry and psychology train- ing programs. Elizabeth Newlin, M.D., program and medical director of The Menninger Clinic and assistant professor at the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, echoed these sentiments and said investing in the future workforce is one way Menninger is addressing both the quality of adoles- cent mental health care in Houston as well as the quantity. treatment programs, and school and community-based interventions they need. Even more, it could generate a surge of early treatment and prevention programs throughout the city—some- thing many clinicians believe could have the greatest benefit of all. "The thing is, when you talk to an adult about their mental health prob- lems, regardless of what it is, and you ask them when their symptoms began, the vast majority will tell you that their symptoms started in childhood. It's not like you turn 18 and suddenly you have mental health problems," said Williams. "One of the things that motivates me as a child psychiatrist is that I wanted to see if maybe we could change the outcome." That's the shared goal—one that the institutions believe can be accom- plished with the right resources and a culture of collaboration. "One of the greatest opportunities that we have as mental health profes- sionals in the TMC is to create a stron- ger network or 'think tank' combining all of our thought leadership to develop actionable ideas that would result in more prevention and treatment options for pediatrics as well as adolescents here in Houston," Newlin said. "It will take time, but that to me is how we can graduate from an awareness level to a problem-solving level, and that's how we can all reach even more young people throughout the Greater Houston Community." Shah reiterated that it is not a prob- lem for one institution to shoulder. "All involved parties need to come forward and work on a resolution, because we're truly talking about our future generations here."