Five Questions With: Dr. Gregory Fritz

"I hope, and believe, that we are on the cusp of some important scientific advances that will lead to new medications and more effective use of existing medications."

Dr. Gregory Fritz is president-elect of the American Academy of Child and Adolescent Psychiatrists. The group advocates integrating mental health and conventional pediatric care in shared facilities. Fritz is also academic director of Bradley Hospital, associate chief and director of child psychiatry at Rhode Island Hospital and Hasbro Children’s Hospital, and vice chair of the department of psychiatry and human behavior at Warren Alpert Medical School of Brown University. Hasbro Children’s is a nationally known leader in integrated care.

PBN: Is it theoretically possible that integrated care would lead to a time when social stigma surrounding mental illness would come to a complete and total end?
FRITZ:
Integrating medical and mental health care, on an equal footing, is a huge step toward eliminating the stigma of mental illness. Which is the cause and which is the effect is difficult to tease out. Integration of care cannot happen if mental illness and its treatment are too stigmatized to be discussed openly and thoughtfully, so progress in reducing the stigma (which clearly has occurred in recent years) is one of the factors behind the integrated care movement.

PBN: How big an impact will the earlier care made possible by integrated have on childhood mental health problems? What are you seeing already at Hasbro as a result of earlier treatment?
FRITZ:
Since the brains of children and adolescents are still in very active stages of development, the earlier problems are identified and addressed, the easier and more effective the treatment. Long-term, the benefits of such early intervention will have huge benefits for the individual and for society, persisting through adolescence into adulthood. The movement toward integrated care got a big boost from the Affordable Care Act but the full benefits will accrue over years (assuming we don’t decide to return to our previous system of fragmented, solely disease-focused medical care).

PBN: What is the average age of onset for childhood mental health problems?
FRITZ:
Different childhood disorders typically begin at different times but overall, half of all lifetime cases of mental illness begin by age 14. About 20 percent of children and adolescents aged nine to 17 have a diagnosable psychiatric disorder with 5 to 9 percent showing “extreme functional impairment.”

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PBN: Are integrated care practitioners able to treat the family holistically – to address problems that may spring from the home environment?
FRITZ:
Even before integrated care became widely appreciated, pediatricians and child mental health professionals widely recognized that a child’s dependency on adults makes it essential to involve the family and other adults (teachers, social workers, etc.) in the child’s care. The changes in the payment system that facilitate integrated, holistic care are only beginning to occur so to a large degree we are still operating in the old fee-for-service model in which only face-to-face contact with the identified patient for established disorders gets paid. Consultation between professionals, care coordination, and early intervention (before a full-blown disorder exists) are still difficult or impossible to get reimbursed.

PBN: About what percent of childhood mental health patients receive prescription drugs as part of their treatment at present, and where would you like to see that percent be 10 years from now?
FRITZ:
I don’t know the percentage currently and what it is in the future depends on what new medications are available. I hope, and believe, that we are on the cusp of some important scientific advances that will lead to new medications and more effective use of existing medications, in which case the proportion of patients receiving them should increase. The timeline for this is hard to predict but the potential for integrated care systems to provide better data on what treatments do and don’t work should accelerate the process.

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