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A new study looked at the treatment of insured children (average age 12) after they experience a first mental health episode. Most of these children were experiencing anxiety or depression.

“We looked at the treatment of these children received in the three months after the incident and focused on whether they had received any follow-up care in that interval, whether they received any therapy, and the types of drugs they received if they received drugs,” study author Janet Currie told us. “We were hoping to find out how treatment varied across the country and whether variations were mainly explained by shortages of mental health professionals.
 
There is a lot of previous literature showing that there are geographic variations in the type of care that patients receive.  However, very little of this work looks at children.

“Also, there are relatively clear guidelines about how children who are newly treated for mental health should be treated,” Currie told us, “so we thought it possible that these guidelines would mean that there was little variation across the country.”
 
Currie has done a lot of previous work on child health and some of that work shows that mental health problems have especially negative effects on children's future outcomes such as educational attainment and employment. 

“Since mental health is so important, I wanted to see how it is being treated across the country,” Currie told us, “and whether the results might suggest some improvements that could be made.”

Researchers used a national database of insurance claims, which contained more than two million children. There were 202,066 with at least one claim related to mental illness, which they used in their analysis.

“Since common medical advice suggests prompt follow-up treatment, we looked at the treatment offered within three months,” Currie told us. “We looked at cases of no therapy whatsoever, drug treatment only, and a mix of therapy and drug treatment.  I would recommend you look at the methods and materials section in our study for more detailed information.”
 
Less than half of children received any therapy within three months, and 22.5 per cent of children received only drug treatment. Of the children receiving drugs, 45 per cent were prescribed drugs in the benzodiazepine class (which are addictive), tricyclic antidepressants (which can have severe side effects), or drugs that were not FDA-approved for use in children for any indication.
 
“I think the results are very surprising, especially since most of these children were at the very beginning of treatment,” Currie told us. “It is very surprising that so many of these insured children lacked follow up care within a reasonable time frame, and failed to receive any therapy.”

Currie said it’s also surprising that so many of these children were prescribed drugs that really raised a red flag. If the children had not received any previous medications, why would you start with drugs that were not FDA approved for use in children or that had potentially dangerous side effects? 

“If you point out to medical people that there are some places where kids seem to be getting sub-standard care, a standard response will be that that is because there is a shortage of trained providers like child psychiatrists,” Currie told us. “And indeed, there are areas of the country where there are no child psychiatrists at all. But we show that these patterns of treatment occur even in ZIP codes that are relatively well served by child psychiatrists, suggesting that they are not simply the result of doctor shortages.”
 
These results, Currie believes, indicate that many children are receiving questionable treatment. Some practitioners do not appear to be following broadly agreed-upon general guidelines.

“We need to conduct more research to understand these patterns, and their effects on the affected children,” said Currie.