Study illuminates an invisible crisis in children’s mental health

BMJJul 19 2021

One in eight children have mental disorders that cause symptoms and impairment and therefore require treatment, but even in high-income countries most of these children will not gain access to services to treat them, reports a study published in the journal Evidence-Based Mental Health.

Mental disorders that start in childhood and adolescence can significantly interfere with wellbeing and development.

Despite the social and economic implications of not addressing these disorders, including long-term healthcare costs, justice system costs and the loss of human potential, mental health service provision for children continues to lag behind provision of services for physical health conditions, even in high-income countries.

To gain a better understanding of the burden of mental disorders in children and their treatment, the authors analyzed data from 14 studies in 11 countries published between 2003 and 2020. The countries were the US (four studies) and Australia, Canada, Chile, Denmark, Great Britain, Israel, Lithuania, Norway, South Korea and Taiwan (one study each).

The studies included 61,545 children aged 18 years or younger and the analysis showed that the overall prevalence of childhood mental disorder was 12.7%.

The most common mental disorders were anxiety (5.2%), attention-deficit/hyperactivity disorder (ADHD) (3.7%), oppositional defiant disorder (e.g. argumentative behavior) (3.3%), substance use disorder (e.g. problematic use of alcohol or cannabis) (2.3%), conduct disorder (1.3%) and depression (1.3%).

“Concerningly, only 44.2% of children with mental disorders received any services for these conditions,” the authors say. “In contrast, robust services are in place for child physical health problems such as cancer, diabetes and infectious diseases in most of these countries.”

These shortages also exist despite considerable research evidence on effective interventions for preventing and treating childhood mental disorders.

They say their findings have illuminated “an invisible crisis in children’s mental health.” “We have depicted a high prevalence of childhood mental disorders coupled with unacceptable service shortfalls in high-income countries—to a degree that violates children’s rights.”

High-income countries can “afford to do better,” they add. “Many countries will need to substantially increase children’s mental health budgets.” They noted, “This is particularly urgent given documented increases in children’s mental health needs since COVID-19—needs which are predicted to continue.”

The authors note several limitations in their paper, particularly variations in methods used in the included studies, including their diagnostic approaches and how they assessed service use. Nevertheless, all studies reported data on children who had not only symptoms but also impairment as a result of their mental disorders, underscoring the need for treatment.

“We believe that our review can enable policymakers to better understand the mental health needs of children in high-income countries,” they say. “In particular, policymakers can use our prevalence figures as benchmarks—calculating the numbers needing treatment at any given time within a given population or jurisdiction, then comparing the numbers in need with the numbers actually receiving mental-health services.”

They point out that families may seek services for children experiencing distress who do not meet diagnostic criteria meaning the prevalence data may under-represent service need.

The studies which assessed service use mainly captured contact data, so there were limited data on the type, duration and intensity of any treatment intervention which would be useful for service planning, the authors add. They stressed that it is also crucial for policymakers to ensure that effective services are offered, whether for prevention or treatment.