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H H S Department of Health and Human Services
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Maternal and Child Health

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Mental Health and EPSDT: Need for Services

The need for screening, diagnosis and treatment services for children's mental health

“Recognizing (mental health) problems and providing necessary care and support as early as possible literally changes lives.”

— U.S. Surgeon General, Mental Health: A Report of the Surgeon General, 1999

Mental Health Conditions are Prevalent Among Children

Whether referred to as social/emotional, behavioral, or mental health problems, many children experience difficulties that affect their family lives, schooling or ability to make friends.  

  • Among US youth 13-18 about 20 percent reported that they suffered from a mental disorder with symptoms severe enough to impair their daily lives. (Merikangas, Burstein, et al, 2010)
  • Approximately 11-13 percent of children and youth have a serious emotional disturbance (SED) that causes substantial impairment in how they function at home, at school, or in the community, and for 5 percent a serious emotional disturbance causes extreme impairment in their functioning (Surgeon General’s Conference on Children’s Mental Health; Merikangas, He, et al, 2010).
  • Primary care providers increasingly see social-emotional problems. Psychosocial problems are increasing in frequency - from 7 percent to 19 percent - as a reason for pediatric office visits (Kelleher et al, 2000 .)  
  • Infants and very young children can experience problems in their social and emotional development.  Research shows that mental health conditions among infants and toddlers can be real and persistent. (Zeanah and Zeanah, 2009; Scheeringa, Zeanah, et al, 2005) Recent studies find that 3- and 4-year-olds are being expelled from preschool because of problem behaviors. (Gilliam & Shahar, 2006 .)
  • Parental depression can have a serious impact on children’s physical and mental health and overall well-being.  An estimated 15.6 million children under age 18 are living with an adult who had major depression in the past year. (England and Sim, 2009
  • Maternal depression affects approximately 10 percent of mothers with young children, and 48 percent of mothers enrolling children in Head Start. Maternal depression puts children at greater risk for a range of problems including lower activity levels and problems with social interactions. (Knitzer, Theberge & Johnson, 2006 )

Early Detection Can Help

Proven treatments are available for many childhood mental health conditions. Successfully addressing mental health problems in childhood can prevent or reduce school problems; improve relationships with adults and peers; reduce risk-taking, substance abuse, and criminal behavior; and prevent or reduce adult psychiatric problems. The healthy mental development of young children is an important component of school readiness and success.  

Mentally healthy children and adolescents enjoy positive quality of life; function well at home, in school, and in their communities; and are free of disabling mental health conditions. (Hoagwood et al., 1996)

Many Children Do Not Get Needed Services

Many children with social-emotional problems or mental health conditions are not identified or do not receive interventions to address them. 

  • Results of the National Comorbidity Survey-Adolescent Supplement (NCS-A) indicate that approximately one third of adolescents with mental disorders receive services for their illness. (Merikanga He, et al. 2011) Hispanic and non-Hispanic Black adolescents are less likely than their White counterparts to receive services for mood and anxiety disorders.
  • Data from the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey (NHANES) show that approximately half (50.6 percent) of children with mental disorders had received treatment for their disorder within the past year. There were some differences between treatment rates depending on the category of mental disorder. Children with anxiety disorders were the least likely (32.2 percent) to have received treatment in the past year (Merikangas, He, et al. 2010).
  • The National Survey of Children with Special Health Care Needs (CSHCN) found that among the children who had a need for mental health services during the prior year, 20 percent did not receive such care.  (Derigne, Porterfield & Metz, 2009)