Читать книгу Introduction to Abnormal Child and Adolescent Psychology - Robert Weis - Страница 55

Researchers and policy experts have identified several barriers to families’ access to high-quality mental health treatment (Garland et al., 2013; Santiago, Kaltman, & Miranda, 2013). First, economic barriers can limit children’s access to treatment. Psychotherapy, medication, and other forms of treatment can be expensive. Even families with private health insurance may be limited in the duration or type of treatment they can receive. Low-income families may face the additional challenge of obtaining treatment from a public social service system that is often overburdened and underfunded. Low-income parents also face practical barriers to treatment, such as finding time off work, transportation to and from sessions, and childcare for their other children.

Second, social–cultural factors might decrease a family’s willingness to participate in therapy. For example, some ethnic minority families may perceive psychological treatment to be ineffective or irrelevant to their immediate concerns. Instead of seeking psychotherapy or counseling, these families might consult with physicians, clergy, or elders in their community for treatment, advice, or support. Other parents from culturally diverse backgrounds might view therapies developed primarily for White, middle-class families as inapplicable to them. For example, some parents might disagree with therapists’ recommendation to avoid spanking children when they misbehave. Still other parents may be unable to find therapists who can communicate in their language (American Psychological Association, 2017b).

Even if families are able and willing to participate in treatment, they may be unable to find high-quality mental health services. As we will see, evidence-based mental health treatments are not available in many communities. For example, multisystemic therapy is an effective treatment for older adolescents with serious conduct problems. Many well-designed studies have shown multisystemic therapy to reduce adolescents’ disruptive behavior problems, improve their social and academic functioning, reduce their likelihood of arrest and incarceration, and save the community money (Dopp, Borduin, Wagner, & Sawyer, 2014; van der Stouwe, Asscher, Stams, Deković, & van der Laan, 2014). However, few clinicians are trained in providing multisystemic therapy, and it is available in only a small number of communities.

Third, there are simply not enough experts in child and adolescent mental health to satisfy the need for services. Our current mental health system is able to address the needs of only about 10% of all youths with psychological problems. Furthermore, only 63% of counties in the United States have a mental health clinic that provides treatment for children and adolescents (Cummings, Wen, & Druss, 2013). Youths who receive treatment are typically those who show the most serious distress or impairment. Youths with less severe problems, such as moderate depression, mild learning disabilities, or unhealthy eating habits, often remain unrecognized and untreated until their condition worsens. Inadequate mental health services are especially pronounced in disadvantaged communities.

Finally, stigma can interfere with children’s access to mental health treatment (O’Driscoll, Heary, Hennessy, & McKeague, 2012). Stigma refers to negative beliefs about individuals with mental disorders that can lead to fear, avoidance, and discrimination by others or shame and low self-worth in oneself (Corrigan, Bink, Schmidt, Jones, & Rüsch, 2016). Stigmatization of mental illness comes in many forms. During casual conversation, people use terms like crazy, wacked, nuts, and psycho without giving much thought to the implications these words have for people with mental health problems. Children may use the derogatory term retard to tease their classmates. Parents of children with psychological disorders often report discrimination from school and medical personnel because of their child’s illness. Some insurance companies discriminate against individuals with mental disorders by not providing equal coverage for mental and physical illnesses. Movies and television shows unfairly depict people with mental health problems as violent, unpredictable, deranged, or devious. Even children with mental disorders are portrayed in a negative light (Martinez & Hinshaw, 2016).

Some parents are reluctant to refer their children for therapy because of the negative connotations associated with diagnosis and treatment. In fact, roughly 25% of all pediatrician visits involve behavioral or emotional problems that could be better addressed by mental health professionals (Horwitz et al., 2002). Parents often seek help from pediatricians and family physicians to avoid the stigma of mental health treatment. Stigma associated with the diagnosis and treatment of childhood disorders causes many at-risk youths to receive less-than-optimal care (Bowers, Manion, Papadopoulos, & Gauvreau, 2013).

Stigma can also negatively affect youths and their families in several ways. First, it can cause a sense of shame or degradation that decreases self-esteem and lowers self-worth. The negative self-image generated by the social judgments of others, in turn, can exacerbate symptoms or hinder progress in therapy. Second, stigma can lead to self-fulfilling prophecies. Youths may view themselves negatively because of their diagnostic label. In some cases, children may alter their behavior to fit the diagnostic label or use the diagnosis to excuse their behavior problems. Third, stigmatization can decrease the likelihood that families will seek psychological services. Many youths who show significant behavioral, emotional, and learning problems do not receive treatment because parents do not want them to receive a diagnosis (Martinez & Hinshaw, 2016).

Review

 Only one-half of children with mental health problems receive treatment. Non-Latino White children and youths from high-SES families are most likely to receive care.

 Roughly 7.5% of school-age children are taking at least one psychotropic medication at any point in time. Medication is more often used by adolescents (rather than children) and boys (rather than girls).

 Barriers to treatment include financial problems, a lack of high-quality treatment in the community, a shortage of well-trained clinicians, and stigma.