Bradley Hasbro Children's Research Center
An Interview with Gregory Fritz, MD: Integrating Mental Health Care for Children and Teens
What first drew you to the field of child and adolescent psychiatry?
I finished my child psychiatry training and research fellowship in 1977, so I’ve been in the field about 38 years. I majored in American literature in college (at Brown) and have always been interested in what makes people tick. When I added in a medical education, the ways that the mind and the body interact in chronic illnesses became my passion. Working with children, adolescents and their families is a joyful privilege.
What are your major goals as AACAP president?
I think our current health care system is pretty poor, given all the money we spend on it (the most per capita of any country in the world – but the results don’t reflect that). Some people do very well while many get inadequate or no care ever for serious mental health problems. Prevention receives little more than lip service. Access to mental health care is extremely difficult for the poor, minorities, and those living in rural areas.
“Carving out” mental health benefits from the rest of medical care no longer makes even financial sense (which was the reason separate management systems were started by insurance companies in the 1980s) and it carries with it big problems: it reinforces the stigma of mental illness, it institutionalizes the mind/body dichotomy, and it impedes communication between medical and mental health professionals.
My focus during the two years of my presidency will be on integrating pediatric mental health services into primary medical practices, because integrated care can address many of these problems. My personal experience on a small scale says integrated care can happen, and when it does, everyone benefits.
You mention access to mental health services as a big problem. Why is it so much more of an issue now than in the past?
There has always been a shortage of child mental health professionals, child psychiatrists in particular. As the stigma of mental illness declines, as public knowledge about psychological disorders improves, and as the effectiveness of available treatment increases, many more children are being brought for treatment. A longstanding problem of access to psychiatric treatment is becoming much more visible and concerning. I don’t think that fundamentally the number of children needing mental health services has changed dramatically in the past three decades. It’s more that existing problems are now recognized, teachers and other professionals refer children with mental health issues more, and parents are less hesitant to seek treatment. The result: long waiting lists and many untreated children.
With all the pressure to reduce health care costs, do you find yourself having to push back to ensure that children and adolescents get the care they actually need?
There is a tendency for children to be overlooked in all of medicine, since compared to adults they are mostly healthy, pediatric health care costs are much smaller than adult expenditures, and the return on investment for pediatric health care reform is long term rather than immediate. Given that about 80% of children with psychiatric disorders get no treatment at all, reform can improve efficiency and reduce per capita costs – but not reduce the absolute amount that should be spent. I think vigorous advocacy for children’s mental health is essential.
The AACAP has increased its involvement in governmental advocacy for just this reason, and I look forward to participating actively in policy reform.
How does the integrated care model improve access to pediatric mental health services?
With mental health professionals’ consultation and backup – and appropriate reimbursement – primary care providers are competent and confident to manage many pediatric mental health problems. They thus actually increase the workforce available to treat children for whom access to mental health services is otherwise unavailable. Education of both primary care and mental health professionals is key to making the new system of integrated care work, but the potential for improved care and satisfaction is huge.