By Lisa Rapaport

(Reuters Health) – The number of child psychiatrists in the U.S. has climbed in recent years, but a new study suggests gains have been uneven and access to psychiatric care may be getting worse for kids in some parts of the country.

From 2007 to 2016, the number of child psychiatrists in the U.S. increased from 6,590 to 7,991, a 21.3% gain, the study found. The number of child psychiatrists per 100,000 children also grew, from 8.01 to 9.75, a 21.7% increase.

Gains weren’t uniform, however.

Six states – Idaho, Indiana, Kansas, North Dakota, South Carolina, and South Dakota – experienced a decline in the number of psychiatrists per 100,000 children. And another six states – Alaska, Arkansas, New Hampshire, Nevada, Oklahoma, and Rhode Island – experienced at least a 50% increase in the number of psychiatrists per 100,000 children.

“The supply of child psychiatrists in the United States has improved over the past 10 years but a shortage is still profound in large segments of the country,” Ryan McBain of RAND Corporation in Boston and colleagues write in Pediatrics.

More than half of American kids with a treatable mental health disorder do not receive treatment from a mental health professional, McBain and colleagues write in Pediatrics. One of the driving factors contributing to this unmet need is a shortage of child psychiatrists, which is compounded by growing demand for treatment that places additional pressure on a limited supply of providers.

Improvements in screening and diagnosing childhood mental health disorders, and expanded health insurance coverage for psychiatric care, have had the unintended consequence of exacerbating access problems created by a limited supply of providers, the study team notes.

Historically, the shortage of child psychiatrists has been most acute among disadvantaged populations, such as racial and ethnic minority youth, as well as youth living in impoverished and rural areas, the study team writes.

The current study offers fresh evidence of these disparities.

Child psychiatrists were significantly more likely to practice in high-income counties, as well as in counties with higher levels of postsecondary education, and metropolitan regions.

“The distribution of child psychiatrists also remains inequitable, with a state like Massachusetts having as many child psychiatrists as Oklahoma, Indiana, Georgia, Mississippi, and Tennessee combined, despite these latter states having five times as many children ages 0 to 19,” the study team writes.

Limitations of the study include a lack of data on the type of offices where child psychiatrists practiced or how engaged individual clinicians were in these practices, which could impact kids’ access to mental health care, the study team notes. Researchers didn’t know if psychiatrists worked part-time or infrequently as opposed to full-time, or how many of their working hours were devoted to caring for children.

Another drawback is that researchers could not examine changes in the prevalence or severity of pediatric mental illness during the study period, or determine whether any changes might be due to shifts in the clinician workforce that led to more diagnosis or screening.

“Unfortunately, there is evidence that the burden of mental illness in youth has significantly increased over the past decade,” Dr. David Axelson of the department of psychiatry and behavioral health at Nationwide Children’s Hospital in Columbus, Ohio, writes in an editorial accompanying the study.

“Poor access to child and adolescent psychiatrists has long been a concern raised by pediatricians, families, and other stakeholders,” Axelson writes. “Wait times for new appointments can be many months, and families may be required to travel long distances.”

SOURCE: http://bit.ly/34x1gAp Pediatrics, online November 4, 2019.