Dismiss a child's seriously disruptive and aggressive behavior as a normal stage of adolescence and the real culprit of a mental illness may be buried for years.
According to the Surgeon General's "National Agenda for Children's Mental Health," which was published Jan. 3, the nation is facing a public crisis.
One in 10 children and adolescents in the United States suffers from a mental illness severe enough to cause some impairment, according to the report. It is estimated that fewer than one in five of these children receive needed care.
Dr. Richard Buccigross, clinical director of Sharp Mesa Vista Hospital's child and adolescent services, the largest private psychiatric hospital in San Diego County, estimates between 15 and 20 percent of children living in the United States suffer from a mental illness.
"The stigma attached to mental illness causes people not to identify and seek treatment," Buccigross said. "Very often parents, teachers and primary care providers will ignore behavioral problems or dismiss it."- Room For Advancement
In San Diego, real advances in identifying children with mental problems and offering proper care have yet to be made, local mental health professionals said.
Problems range from a limited number of hospital beds and treatment centers to a critical shortage of mental health professionals. The problem is exacerbated by inadequate reimbursements from health plans and government agencies to provide needed care, they said.
"We have more children with mental health problems than we have facilities," said Dr. Rodrigo Mu & #324;oz, past president of the American Psychiatric Association in Washington, D.C. "We know of the many people who have problems as adolescents and adults who weren't treated as children."
In San Diego, where more than 640,000 residents are without health insurance, the problem is especially troublesome.
About 14,000 children in the county have been diagnosed with some kind of serious mental disorder and need treatment, said Steve Escoboza, acting director of the county Health and Human Services Agency.
Many children served by the county's mental health program are on Medi-Cal, or with limited or no health insurance, he said.- County Program Should Be Better
Alfredo Aguirre, director of the county's mental health program for children, said a new integrated program promises better care.
The county Board of Supervisors approved the program last October after five years of pondering different proposals.
The program started Jan. 16. It will serve 450 children in its first year of operation at a cost of $13.5 million, Aguirre said.
Care will be provided via two contractors:
They are the Child and Youth Family Network, a consortium of 10 nonprofit agencies which will manage the cases of the most seriously mentally ill patients, and the Community Care Systems, which will track the progress of treatment and train family service coordinators.
Contracts also exist with day-treatment providers, such as the Behavioral Health Group in San Ysidro and Sharp Mesa Vista Hospital, and residential facilities, such as the San Diego Center for Children and New Alternatives Inc. in Chula Vista.
Sadly, Aguirre's enthusiasm for the program isn't shared by everyone in the community.
"I have a lot of faith in him (Aguirre)," said Mu & #324;oz. "My lack of faith is in the system."- System Remains Underfunded
Mu & #324;oz, who is a psychiatrist and the medical director at the Scripps Health adult mental health program, criticized the new system for lacking an efficient method to identify and treat children with mental problems early on. It also remains critically underfunded, he added.
Mu & #324;oz said learning disabilities, anti-social and disruptive behavior, drug use, guns, violence, poverty and unemployment of parents all have negative effects on children's psychological health. If they aren't identified early, the problems get worse later on, he said.
He sees severely dysfunctional children under age 18 every day. Their ailments range from acute psychotic behavior and drug and alcohol abuse to attempted suicide.
The most severe cases are stabilized within 72 hours in voluntary detention.
They are followed up in a day-program, where children go to school while receiving medical care. Others receive outpatient care.
The kind of care patients are eligible for is dictated by their managed care provider or Medi-Cal, he said.
"Historically there have been severe restrictions placed on access to psychiatric care," he said.- Patients Face Obstacles
Many families don't have the financial means to pay for additional recommended treatments.
And despite the recent implementation of mental health parity, many patients still don't receive the kind of care they need, he said.
Dr. Eve Dryfus, medical director and child psychiatrist at the San Diego Center for Children, said families get discouraged every day by what she coined the "complicated maze of mental health."
That involves searching for the right program, then getting the money to pay for it.
At the center, 140 children are cared for by 150 employees.
About 100 mentally ill children are seen at one of two day-care programs, either in Kearny Mesa or in Lemon Grove, she said.
The most severe cases who failed all other levels of care , that is children diagnosed with multiple psychiatric disorders, some of whom were sexually and physically abused , end up in the residential program.
This 24-hour program is the costliest kind of care and grossly underfunded, Dryfus said. Two-thirds of the children at the center are on Medi-Cal insurance; one-third are privately insured, she said.- A Network Of Referrals
The children are referred to the center from places such as the welfare system, law enforcement, medical professionals, the county and the school system.
Aguirre said mental health services are now offered in 146 local schools, up from 29 schools in October 1999.
He also said the county hopes to draw additional state funding.
Aguirre, a trained social worker, admits the system isn't perfect, but said people need to be responsible in assessing children's mental health care needs.
"We don't want to over-identify children to draw more dollars," Aguirre said. "We have to be careful that our own ethnocentricity doesn't get in the way of identifying children."
Mu & #324;oz, however, has the opposite view.
He said the reality is that poor African-American children get overlooked the most.
That also goes for poor Hispanic children, many of whom have the additional burden of dealing with cultural identity issues, he said.
Spotting a mental illness in children is extremely difficult, and especially hard for parents to come to terms with, Dryfus said.
"(Contrary to adults) children show their behavior, they can't articulate it," Dryfus said. "This makes diagnosing a child more difficult."