The Workforce Shortage of Child and Adolescent Psychiatrists: Is It Time for a Different Approach?

Psychiatric disorders affect a large number of children around the world. Recent data have reported that approximately 10% to 13% of children have a serious emotional disturbance with significant functional impairment, suggesting that at least 1 in 10 children require mental health services.1,2 Approximately half the adults with mental illness received their diagnosis before 15 years of age3 and close to three fourths of mental health disorders start by the mid-20s.4 Mental illnesses are associated with a large disease burden because these conditions lead to increases in morbidity, mortality, and financial costs. For example, in high-income countries such as the United States, 3 of the leading illnesses associated with pediatric disease burden are psychiatric (depression, bipolar disorder, and schizophrenia) and psychiatric illness in children and adolescents is a key risk factor for completed suicide.5 In the United States, suicide is the second leading cause of death in people 15 to 24 years of age,6 with rural areas having particularly high suicide rates.7 What is even more disconcerting is the fact that most youngsters who might benefit from psychiatric or behavioral health treatment do not receive it. For example, only 45% of adolescents with mental illness received psychiatric services in 2013. This number is even smaller for children and adolescents with internalizing disorders and for minorities.8 .