In Rhode Island and nationwide, children and teens who need mental health services often cannot get them. The problem: a serious and growing shortage of providers. There are only about 7,000 child and adolescent psychiatrists nationwide, and only about 300 new ones complete training each year. With growing numbers of youngsters now diagnosed with a psychiatric disorder at some point, the use of child psychiatrists is expected to double by 2020, while the number of providers is expected to grow by only 30 percent.

Dr. Gregory Fritz, academic director at Bradley Hospital, has been active in efforts by the American Academy of Child and Adolescent Psychiatry to address the problem. He spoke with Providence Business News about the shortage, its impact on children, and what can be done.

PBN: How serious is the shortage of child mental health professionals?

FRITZ: By all accounts, from the surgeon general down to individual experiences, it’s very serious across the country. No place is immune from it, though some places are worse than others. [Massachusetts has the least-severe shortage, while Rhode Island is about in the middle of the pack.] But it’s more complicated than how many children who seek treatment can’t get it. Because every epidemiologic study of any psychiatric disorder in children – including the most common ones, attention deficit disorder and depression – shows there are more children who are not receiving treatment than who are. So there’s this vast group of kids, even in Massachusetts, that aren’t receiving treatment. ... And there are many factors involved with that. Lack of availability of treatment is one of them – there are long waiting lists – but it also has to do with ignorance and stigma.

PBN: Going back to the shortage, why are there so few psychiatrists available to children?

FRITZ: There’s no accepted metric for how many child psychiatrists there should be per 100,000 population. But the other thing is if you have 10 child psychiatrists, that doesn’t mean that they all are available to treat kids. Like in Massachusetts and Rhode Island, where we’re relatively research-heavy, there are many child psychiatrists who spend their time doing research. So yeah, they’re counted in that ratio, but they’re not available to see kids. Another factor is that child psychiatrists are also board-certified in adult psychiatry. Nationally, most child psychiatrists see both adults and children.

PBN: How does the shortage affect kids? Do you see kids at Bradley who have no good outpatient options to follow up after a hospitalization?

FRITZ: Absolutely. It’s always a challenge to find a follow-up for kids after they are discharged. The community mental health centers are overburdened, and the practitioners in the community are full and have months-long waiting lists. ... The other thing that we see is kids coming into the emergency room who have had their symptoms for quite a while, who have been on a waiting list, or whose parents have been calling around without success, and during that time, the kid deteriorates. Frequently, that comes down to a suicide attempt. Kids who attempt suicide often are found to have been depressed and having increasing trouble, and the parents were trying to get help, and they weren’t successful. ... Sometimes it’s easier to admit a child into a hospital than to find an outpatient therapist. It should be the other way around – hospitalization is the last resort. It should be easier to find outpatient help and prevent the more expensive and more disruptive treatment of hospitalization.

PBN: Why are so few psychiatrists choosing to work with children?

FRITZ: There are a number of reasons. One is that compared with most specialties, child psychiatry pays poorly, even though the training is among the longest of any regular specialties. Most insurance companies reimburse a diagnostic assessment, whether the patient is an adult or a child, but it takes longer to do a competent job with a child, because you have to talk not only to the child, but to the parent, usually the school and other adults. A child can’t just sit there and tell you what’s wrong. ... Another reason is that the requirement is that you first have to be an adult psychiatrist, then become a child psychiatrist. So some medical students who really love to work with children say, “I don’t want to spend three years doing adult psychiatry, which I don’t want to do – I’m going to go into pediatrics.” We’re trying to develop alternative pathways to becoming a child psychiatrist, but no one ever said the medical establishment is easy to change.

PBN: What else are you doing to address this shortage?

FRITZ: Well, the academy is trying to change the payments and incentives. Actually, [U.S. Rep.] Patrick Kennedy introduced a bill for us that would provide loan repayments for medical students who choose child psychiatry, or scholarships to psychology students in graduate school, so there would be a government-sponsored incentive .. and also an incentive for hospitals to train more [child psychiatrists]. We have also tried to add alternative pathways to becoming a child psychiatrist, as I said, that don’t entail the three years of adult training. About a year ago, we got it passed that programs could be established for people who are already trained pediatricians but are doing a lot of child psychiatry by default to get their training in three years, instead of five. So that’s a good deal. And some of us dare think about the possibility of having child psychiatry-only training, though that is really a long shot. And we’re doing a lot to publicize the excitement of child psychiatry and the opportunities, and increase the visibility of child psychiatry in medical schools.

Bradley Hospital, founded in 1931 as the Emma Pendleton Bradley Home, is the nation’s first psychiatric hospital for children and adolescents and a teaching partner of Brown University’s Warren Alpert Medical School. It is a member of the nonprofit Lifespan health care system, along with The Miriam, Newport and Rhode Island and Hasbro Children’s hospitals. To learn more, visit www.lifespan.org/bradley.