By Micaela Adams
Poverty has always been linked with increased risk for psychological disorders in children and adults, due to poor housing, limited resources, inadequate schools, and high rates of crime and violence. Statistics show that despite this correlation, mental health specialists disproportionately see low-income families. It is estimated that among children experiencing poverty who have parent-reported mental health problems, less than 15% receive services. There are a number of barriers to access, including lack of insurance, lack of transportation, conflicting schedules with work hours and business hours, and stigma, or negative associations with mental health treatment. Children and families experiencing poverty encounter both the stigma of mental health treatment and the stigma of living in poverty. Many mothers in particular report fear of being labeled “crazy” if they or their children are diagnosed with a psychological disorder, which could result in their children being taken from them. Despite this, it has been proven that benefits of intervention are most significant if applied during the early childhood period.
To combat early childhood development of poor mental health among children experiencing poverty, a number of evidence-based treatments have been developed and implemented. Primary care providers are usually the first, if not only, resource low- income families have for mental health services, but these providers often report that they are not formally trained in these services and do not have the time or resources to provide this care. Furthermore, they do not have the skills or training for mental health practice within the context of poverty, which introduces nuances in the traditional diagnostic framework. Evidence suggests “programs that are family-driven, target children in their natural contexts, incorporate evidence-based interventions, and take a comprehensive approach to treatment that addresses relevant social determinants (eg, housing or food insecurity), may be associated with greater therapeutic changes” (ncbi.nlm. nih.gov). These services, however, are limited, and so the focus is more on strategies that can be implemented in pediatric primary care settings.
This behavioral health care is being integrated within the patient- centered medical home, which decreases the barrier of accessibility to services among families experiencing poverty. This could involve routine mental health screening as part of well childcare, to having mental health providers within a primary care practice. However, this is not being widely implemented, due to lack of time, lack of reimbursement, lack of available mental health resources, and potential liability issues. Still, families who discuss their children’s psychological problems with their pediatrician are more likely to eventually obtain more intensive mental health services. Therefore, referral to external resources by pediatricians is crucial, as is the primary care provider’s awareness of the barriers to care and cultural sensitivity, in order to encourage families to engage in their child’s mental health care.
Ideally, primary care providers would integrate mental health professionals into their practice, which studies have shown is associated with higher rates of treatment initiation. However, if a mental health ‘team’ of psychiatrists and psychologists were to provide consultation to pediatricians, this would offer a cost-effective method to allow pediatricians to implement mental health intervention. The focus of health care providers needs to be in building integrated care models, in order to affect the number of children experiencing poverty with poor mental health.