"Poor states in general have worse access and then within a given state poor people have worse insurance coverage which means they have less access."
By Harold Ambler Contributing Writer
Dr. Gregory Fritz is the academic director of Bradley Hospital. He is also a professor and director of the division of child and adolescent psychiatry in the department of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, and director of child and adolescent psychiatry at Rhode Island Hospital.
Fritz graduated from Brown University in 1967 and earned his medical degree from Tufts University School of Medicine in 1971. From 1977 to 1985, Fritz was a faculty member in the department of psychiatry and behavioral science at Stanford University School of Medicine in Palo Alto. During that period, he was director of consultation-liaison psychiatry at the Children's Hospital at Stanford.
In 1985, Fritz moved to Rhode Island to build a comprehensive pediatric psychiatry service at what is now the Hasbro Children's Hospital. Under his leadership, the program has grown to be one of the premiere academic sites for pediatric psychosomatic medicine.
PBN: To what degree is children's lack of access to mental health care a factor of socioeconomic background – do kids from disadvantaged backgrounds have an especially hard time gaining access to care?
FRITZ: It’s a significant factor. Poor states in general have worse access and then within a given state poor people have worse insurance coverage which means they have less access. That said, I don’t think anyone is spared the problems of the shortage of child mental health professionals.
PBN: What has been the most hopeful period of your career regarding children’s mental health services? Is it always the best of times and the worst of times to some extent?
FRITZ: I think things keep improving, but clearly there’s still a long way to go. In my career, I think now is the best time, because we know more, meaning there’s been a lot of useful research, and there are better treatments available. There’s also a greater awareness of the importance of mental illness in children and, though it still exists, there’s less stigma.
PBN: What trends in children's mental health are you particularly concerned about?
FRITZ: The one I’m most concerned about is what I think is overprescribing psychoactive medications to very young children. The problems with that are that there is almost no data to guide us. We don’t know what the long-term effects of these medications are. And whatever they are, they’re probably more dangerous for very young children because their brains are still very much developing. The other thing is that too often these medications replace what should be appropriate and useful psychosocial treatments. I think the reason they replace them is not out of choice. It’s a lack of availability of mental health professionals who can do the more costly psycho-social treatments, or they don’t know how to work with little kids. It’s generally a desperation move to prescribe those treatments to little kids.
PBN: Do you see the Affordable Care Act’s provisions regarding parity for mental health services affecting things for children yet? Are you hopeful that the ACA will be a game-changer in this regard?
FRITZ: There isn’t much of an effect yet of the ACA or the parity law, but it’s imminent, and there are pilot projects getting under way that wouldn’t have been possible before the ACA. There is a lot of discussion about new models of integrated care for mental health and medical health, with both being provided, concurrently, in the same location. The system by which mental health services were carved out for separate administration from physical health is not long for this world.
PBN: How difficult is it for families with mentally ill children to avoid getting caught up in shame or stigma?
FRITZ: It’s difficult for the adults in the families, the kids haven’t learned to stigmatize mental illness yet. Or they’re just beginning to be taught. That’s one thing that child mental health clinicians love about working with kids; they’re often very natural and easier to work with than adults. But the parents are hard to work with, because they have taken that stigma on. A lot of us are doing just what I’m doing. I think the media have a lot to do with it. Anytime a mental health official sounds reasonable and compassionate that’s a shot against stigma, and then when a celebrity or well-known person comes forth, Patrick Kennedy comes to mind, that’s incredibly powerful. I think Patrick Kennedy has done as much as anybody in the country to reduce stigma. It’s really noticeable in my career that there is a significant reduction in stigma.