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Q&A on children’s mental health: More awareness, resources needed

REUTERS/Carlo Allegri
How parents or adult caregivers respond and talk to children about events like the shooting at Sandy Hook Elementary School is very, very important.

Today is National Children’s Mental Health Awareness Day, although setting aside one day a year to focus on the issue seems hardly sufficient. Across the country — and here in Minnesota — it’s estimated that one in five children has a mental-health challenge that significantly interferes with the child’s development, learning, relationships and physical health. Yet only 20 percent of those children are receiving the mental-health services they need.

Earlier this week, MinnPost spoke about the mental-health challenges facing Minnesota’s children with Steve Lepinski, executive director of the Washburn Center for Children, a nonprofit organization that has been helping Twin Cities children overcome social, behavioral and emotional problems for 130 years. Last year, the center, which has offices in Brooklyn Park, Minnetonka and Minneapolis, provided almost 3,000 children and their families with mental-health services — double the number of just six years ago. More than half of those children come from families with low incomes. In recognition of that commitment to kids, Minneapolis Mayor R.T. Rybak has proclaimed May 9 “Washburn Center for Children Day.”

Following is an edited version of the interview with Lepinski.

MinnPost: What is the major mental-health challenge facing Minnesota’s children?

lepinski photo
umn.edu
Steve Lepinski

Steve Lepinski: As a community and as a society — and not just in Minnesota — we don’t understand or pay attention to children’s mental-health issues as well as we need to. Our children’s mental health is as important as their physical health. Most of us, if we saw a child who had fallen off their bike and skinned a knee, we’d stop and help them. With kids [with mental-health problems], the hurt and the pain are on the inside. Too often, we don’t attend to that, or we just don’t see it in the same way. We have a whole lot of children living in pain and parents struggling and kids failing in school because of these issues. Some increased awareness by all of us would greatly help serve our community.

MP: Why don’t we pay attention?

SL: There’s still some fairly significant stigma attached. A lot of times, parents think that if their child is having some type of social-emotional behavioral problem it’s because they didn’t do a good job as a parent, or [they worry that] other people might think that. Also, people don’t understand it. They think this is just a phase that a child is going through, and if they don’t overreact to it, the child will just grow out of it. Too often, unfortunately, it just gets worse instead. There’s also [a lack of] awareness and knowledge of what to look for.

MP: What should parents and other caregivers be looking for?

SL: It varies. Some of the same [mental-health] issues manifest differently in different children. In some school and day-care situations, what tends to get noticed is the aggressive, acting-out behavior. The kids are disruptive and can’t be with other kids, or they hit and bite other kids. Those kinds of things get them in trouble or suspended, and may, eventually, get them to some kind of mental-health professional. At the same time, we have other kids who are suffering maybe similar issues, but who withdraw into themselves and are quiet and passive. Because they don’t come to somebody’s attention in the same way, or because they are not quite as disruptive, some of those kids get overlooked.

MP: Isn’t over-diagnosing a problem, too?

SL: That’s a good point. There is some over-assessment. One of the challenges in diagnosing children is that some of what we see in children mirrors certain developmental issues. Kids have mood swings. Kids are impulsive at times. Kids are fearful of certain things. Those are all normal childhood issues and experiences. In terms of diagnosing mental-health issues, it’s the seriousness or the degree of those issues, or the fact that sometimes they stay over a longer period of time [that raises concern]. It does make assessment and diagnosis very challenging, however. That’s where having a mental-health professional meet with a child can help. [The professional can] either identify something or reassure the parent that the child does not have an issue that needs professional attention.

MP: You’ve been at Washburn for over 25 years. Have you seen any trends in terms of the causes of mental-health problems in children?

SL: Causality is always hard, and it’s often a combination of things. But there are two or three things that we now see quite a bit that we might not have seen as much of in the past. One, there are a lot of children living in poverty. Poverty doesn’t cause mental-health issues, but it can make things worse. When families are really struggling with day-to-day issues  — housing, feeding their children — they may not be able to give enough attention to their children’s behaviors or social-emotional issues. And we’re seeing more children, locally and nationally, living in poverty.

We’re also seeing a lot of various forms of child trauma. It’s related to violence, but it’s not just kids experiencing violence, although that’s part of it. It’s children seeing and hearing more violence on TV and then starting to worry or fixate about it, and to get anxious about it. So, on one hand, we have children who have experienced significant violence in their community or in their life who present with post-traumatic stress disorder. But we also have kids who are just anxious or worried about what they see on TV or hear adults talk about. They may present with childhood anxiety or sleep disorders or failure to concentrate in school.

MP: Are you seeing an increase in emotional problems in children linked to gun violence, or is that just wrapped into the general issue of violence?

SL: In some ways, it’s wrapped in. But when we have more sensationalist kinds of events, like what happened [at the Sandy Hook Elementary School] in Connecticut, kids do both wonder and worry about whether something like that could happen in their school, in their community. How parents or adult caregivers respond and talk to children about those events is very, very important. Acknowledge the issues. Acknowledge the children’s fears. Do not give them so much information that it overwhelms them. But don’t just dismiss [the fears] and tell the child, “Well, that stuff happens, and you just have to learn to live with it.”

Some children live in parts of our community where both gun violence and violence in general is too much a part of life. They hear gunshots in their neighborhood. They know people who have been shot. It creates a kind of pervasive anxiety and worry that they live with on an ongoing basis.

MP: Are we in Minnesota doing enough for our children in regard to mental-health issues? How do we rank compared to other states?

SL: In some ways, I think we rank pretty good. We have done a number of things. We have supported school-based mental-health programs. We have passed policies and legislation that require all teachers to have some training and understanding of mental-health issues. We are screening kids [for mental-health problems] in certain places — in child welfare and in our juvenile justice system. So there are a number of things that have been put in place that are very positive.

I think the biggest challenge — and it’s not just a Minnesota issue, although we see it in Minnesota — is that only one in five kids get the help that they need. Part of that is limited access, and part of what limits access is the availability of resources. There are sometimes not enough resources to ensure that kids get the help that they need, and on another level, some of what is paid to mental-health professionals in terms of rates doesn’t quite cover the cost of the services that are provided. So places like Washburn aren’t able to have sufficient staff to respond to all of the referrals. Instead, we have to say, “You’ll have to wait two months or three months.”

MP: Is there any major piece of legislation that needs to be passed?

SL: A number of pieces of legislation were introduced this year in the state Legislature, and they are still moving through the system. One is an expansion of money to support school-based mental-health services. This is something that the state has been funding for about five years. Programs all over the state have linked with schools to put mental-health professionals in schools or to work with schools. This has been shown to be very effective in terms of increasing access. So the continued expansion of that should be able to help many more children.

There’s also talk about adding what is called care coordination as a benefit that’s paid for and covered. With children’s mental-health services, clinicians often have to coordinate care with schools, with other professionals and with a psychiatrist in the community. Those are things that are all done to support the treatment that’s being given [to the child], but they’re not covered in terms of being paid for, even though professionals spend a lot of time doing them. There’s legislation to include some payment for those kinds of services. That would really help with the array and amount of services available for children.

MP: Do we have enough mental-health professionals to care for children in Minnesota?

SL: Work force is a big issue. If there were a lot more money at the end of this legislative session, or if health plans said they were going to pay 25 percent more to make sure that we cover all children’s mental-health services adequately, places like Washburn and other community mental-health centers throughout the state would be challenged to find enough people, especially enough people who have very good training in child clinical services. So there is a work-force issue. It’s not critical, though. It’s not that if we wanted to hire somebody at Washburn, we couldn’t find that person. But there are shortages in certain areas — working, for example, with early childhood mental-health issues. Sometimes outstate community mental-health centers have a hard time finding people. And [the number of child psychiatrists] is very limited in Minnesota and throughout the country.

MP: What is it like knowing that you don’t have sufficient resources to serve all the children in need?

SL: It’s challenging because you’d always like to be able to do more. On the other hand, at Washburn we’re serving more and more kids each year. And we have had a lot of good outcomes — children whose lives have been changed. There are kids who were told by somebody they would never be able to make it in school, but who, after intensive day treatment for a year, are back in school and managing a full school program. There are kids with anxiety that was really stressing both the child and the family who, after [receiving] outpatient therapy, are doing well, and their family says, “We’ve got our son or daughter back.” It sure would be nice to be doing more and meeting more needs, but on the other hand, we and other mental-health professionals are making a difference in children’s lives every day, and the kids and the families and the communities see that.

You can find out more about the Washburn Center for Children on the organization’s website.

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Comments (2)

  1. Submitted by Paul Scott on 05/09/2013 - 01:55 pm.

    I’d be wary of school based screening, etc

    I find quite a lot to find troubling about smanyme of the assertions made by Mr. Lepinski in this interview. Let’s begin with the premise of a Children’s Mental Health Awareness Day. Did anyone know about this day beforehand, b/c I know I did not, and in the wake of the recent push to prescribe SSRI’s for children off-label, ADHD overdiagnosis, liberal use of anti-psychotics in foster children, not to mention the entire pediatric bipolar disorder fraud that was and still is being perpetrated by prescribers in the last decade, I have to wonder about the interest group that sponsored its creation.

    Mr. Lepinski talks about the environmental stressors that give rise to mental health problems in children, and in this regard he is making sense, but he leaves the realm of reason when he then begins talking about psychiatry. How is medication going to alleviate social problems? How has psychiatry proven itself to be a responsible party in the last two decades when it comes to medication and children? How has Pharma shown itself to be a responsible, let alone useful party when it comes to children and mental health in the last two decades? How do children have the means to respond to mental health treatment when they have no personal freedom and cannot control their environment? Should not the intervention, when it can be applied, be one of behavioral based parent training programs?

    And if the origin of these “illnesses” lie in social problems, then should we not be targeting social problems and supporting children for their resiliency? Mostly I find the idea of empowering the schools to screen for mental illness extremely naive, dangerous, and capable of leading to another generation of kids lost to stimulants when the homes should be shutting off the TV, sedatives, which really have no place outside of a locked ward, and antidepressants that are going to dramatically increase their likelihood of becoming suicidal.

  2. Submitted by Nancy Jost on 05/20/2013 - 11:24 am.

    EARLY CHILDHOOD

    There is an organization called Minnesota Association for Infant and Early Childhood Mental Health (MAIECMH) that brings people together around early childhood mental health issues. I would encourage you to check out the website: MAIECMH.org. Early childhood mental health is an issue that is often over looked but is vital, it effects a child’s life, their school readiness and can have a life-long effect if not addressed. It can even effect a person’slife-long over-all health, also.

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