Children’s takes multifaceted approach in support of childhood mental health

David DeMaso, MD
David DeMaso, MD

This week marks Children’s Mental Health Week and here in Massachusetts we’ve made great strides in ensuring that children and their families have access to high quality mental health care. The passage of 2008’s landmark Act Relative to Children’s Mental Health was a significant step forward in addressing the unmet needs of an estimated 100,000 children who do not receive the mental health care they need. There’s still a lot of work to do, including improving the coordination of care between mental health professionals and families, teachers, pediatric providers and other adults who regularly interact with at-risk children.

Children’s Hospital Boston has been at the forefront in advocating for children’s mental health needs and also in providing children’s mental health care— whether here in the hospital, in our local communities, around the globe and even on the web.

The Children’s Department of Psychiatry has more than 14,000 outpatient visits each year, and 200 inpatient admissions to stabilize children in crisis. We recently sat down with David DeMaso, MD, psychiatrist-in-chief at Children’s and author of the definitive Clinical Manual of Pediatric Psychosomatic Medicine, to explore the reach of the hospital’s mental health efforts beyond the traditional clinical setting.

Beyond traditional clinical care, how else is Children’s treating the mental health needs of children in the hospital?

We realized that there are many very sick children who come to Children’s for cancer, heart disease and other conditions who may be having difficulty coping with the stresses of their physical illnesses. We have long worked to integrate our mental health clinicians into departments and programs throughout the hospital, including primary care, Developmental Medicine, intensive care units, the Transplant Program, the Pain Treatment Service and even the Optimal Weight for Life Program. There is no clear division between physical and emotional health, and we are working to break down these artificial barriers.

Speaking of barriers, many children in the communities surrounding Children’s do not have access to mental health care.  How can we reach them?

mental health factsThere are extraordinary unmet needs in these communities. Access to mental health care can be impeded by so many factors, including stigma, lack of awareness, lack of needed services and even absence of transportation. Through our Children’s Hospital Neighborhood Partnerships, we bring care out to the community. We have prevention programs and provide direct treatment in 15 Boston schools and six community health centers.

We also have established a Center for Refugee Trauma and Resilience, which reaches a somewhat different group of children – refugees who have experienced significant trauma, usually as a result of terrible violence and civil war in their home lands. In recent years, Somalis have been among the largest group of refugees who have resettled in Massachusetts. Many young Somalis are suffering from post-traumatic stress disorder.  Through the center and in partnership with the Somali community, we are delivering evidence-based, comprehensive care to children, youth and families in their own language and culture.

You referred to Somalia. If the needs are this great in the United States, there must be enormous need in other parts of the world for mental health care.
That is true. Many regions lack knowledge of the significant advances that psychiatry has made in treating depression and many other mental health conditions. Children’s mental health clinicians are now working in 17 different countries, including China, Indonesia, Nigeria, Uganda and Tanzania, as well as several European countries to share our knowledge and best practices. We have clinicians on the ground in Haiti, helping providers treat the traumatic effects of the devastating earthquake. Costa Rica, Finland, Norway and Sweden have adapted Dr. Bill Beardslee’s research into national models designed to prevent childhood depression.

How else can we reach children and families?

The Internet is another powerful tool. Several years ago, we created the Experience Journal, an online tool to help children and families contending with serious physical and emotional illnesses. The Web site has 11 different journals, including asthma, cardiac, and transplant, where families can share their stories and experiences about what it has been like to live with their children’s illnesses. This can be of great comfort to people to know they are not alone. Launched in 2001, the site now sees close to 6,000 visitors a month.