Amid rising demand for mental health care for children and teens in crisis, the American Academy of Pediatrics is calling on front-line doctors to get in the game and help spot the early signs of depression in their young patients.
The academy has updated its medical guidelines on adolescent depression for the first time in a decade, with the goal of getting pediatricians to recognize mental health issues in children before they get to the point of needing an involuntary state exam.
Researchers have seen a surge of such exams for minors under Florida's Baker Act, the controversial law designed to commit people for evaluation who are thought to be mentally ill or a danger to themselves.
As many as one of every five teenagers experiences depression at some point during childhood, but they often go undiagnosed and untreated, sometimes because of a lack of access to mental health specialists, according to the academy.
At the same time, suicide remains one of the leading causes of death among American teens.
"There are a lot of barriers to appropriate mental health care, and we're recognizing that many teens are suffering from depression and going a long time without being diagnosed," said Dr. Jasmine Reese, the medical director of the Young Adult and Adolescent Clinic at Johns Hopkins All Children's Hospital in St. Petersburg.
"Depending on where a child might live," she said, "they could have to travel hours to get to a specialist, or insurance might not cover mental health, or there's a very long wait because psychiatrists are overwhelmed with the number of cases. Primary care needs to be front line care for screening these kids."
The academy's updated guidelines were developed by a committee of researchers and clinical experts, including some of its own members and the Canadian Pediatric Society, as well as other mental health associations from both countries.
The guidelines target youths ages 10 to 21 and distinguish the different between mild, moderate and severe forms of depressive disorders. The guidelines also endorse routine depression screenings for children ages 12 and older, a step already recommended by the academy.
"We would like to see teens fill out a depression screening tool as a routine part of their regular wellness visit," said Dr. Amy Cheung, a lead author of the new guidelines. "Parents should be comfortable offering any of their own observations, questions or concerns, which will help the physician get a well-rounded picture of the patient's health."
In the past, according to Reese, general pediatricians have not been trained much beyond what's taught during residency to know how to identify mental health issues and understand the appropriate screening tools available to diagnose something like depression.
"The other limitation is that there's a lot to cover during an annual wellness visit. There's a time barrier. It's easy to miss asking the right questions," she said. "Often times teens and parents aren't separated during these exams, and a teen might not feel comfortable talking about depression in front of their parent. It's all very taboo still and people are afraid to talk about it."
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So additional training is encouraged for physicians, she said.
The topic is more relevant now than ever, Reese said, because of the stress teens face from watching and hearing about mass shootings across the country and close to home.
"Maybe there's a link to social media," she said. "There are a lot more platforms for teens to express their feelings. They're sharing emotions and feelings online in a way that they couldn't have had before these platforms existed."
She said it's hard to tell if there are more mental health issues facing this next generation of young people, or if this group is more willing to speak up about it and get treatment.
Similarly, it's unclear what's behind the rise in exams under the state's Baker Act, said Annette Christy, the director of the Baker Act Reporting Center based at the University of South Florida. From 2010 to 2015, the number of mental health examinations reported by law enforcement, mental health officials or family members on children under 18 rose by 41 percent in Pinellas County and more than doubled in Hillsborough County, according to data from the Florida Department of Children and Families.
Statewide, the increase was 50 percent.
While the jump in the number of exams is staggering, Christy said that it's not necessarily a bad thing.
"Yes, the numbers keep going up and up and up," she said. "But this also means that they're being examined by a health care professional instead of being arrested. So they're not getting pulled into the criminal side of it."
Compared to other states, Florida tends to rank near the bottom when it comes to access to mental health programs, Christy said, citing Gov. Rick Scott's decision not to expand Medicaid in the state, which affected mental health care.
But there's been some improvement, she said.
For example, Scott has signed new legislation allocating $400 million for expanded mental health and new school safety programs, part of the state's response to the deadly Feb. 14 shooting at Marjory Stoneman Douglas High School in Parkland.
The state's Baker Act Reporting Center also tracks mental health first-aid programs, which certify paramedics, law enforcement and others on how to handle a person in a mental health crisis. Those programs also are increasing in number, Christy said.
"This needs to become something that people aren't afraid to talk about anymore," Reese said. "It's an uncomfortable topic in general. But we need to push forward to get child the appropriate care when they really need it."
Staff Writer Laura Morel contributed to this story. Contact Justine Griffin at firstname.lastname@example.org or (727) 893-8467. Follow @SunBizGriffin.