FEATURE ARTICLE
Child and Adolescent Mental Health Services
in Sonoma County
By John Leipsic, MD
As a child and adolescent psychiatrist in private practice, I am frequently asked, “So how’s business?” When I say how busy I am, and that my practice runs full at all times, a common response is, “That’s great, but what does that say about our society that so many kids need psychiatric care?” Actually, it says a lot of good things: that more children are getting care and that more parents are recognizing the mental, emotional and behavioral aspects of their children’s development.
The need for child and adolescent psychiatrists has always been high, with a service demand beyond the capacity of the available workforce. An estimated 20% of children and adolescents have a mental, emotional or behavioral disorder.[1] Without intervention, child and adolescent disorders often persist into adulthood. For example, research has shown that when children with depression and conduct disorders grow up, as adults they use more health care services and have higher health care costs than other adults. Without appropriate early intervention, these childhood disorders may persist and lead to a downward spiral of school failure, poor employment opportunities, and poverty in adulthood. No other illnesses damage so many children so seriously.[2]
The conditions I evaluate and manage range from mild separation anxiety and simple phobias to more severe conditions, such as obsessive-compulsive disorder, Tourette’s, major depression, and treatment-resistant ADHD. One particular diagnosis that has been on the increase is so-called “bipolar disorder.” I try to stay away from labeling kids as “bipolar,” a label that tends to stick. The term “unstable mood conditions” is much more useful and descriptive. I often see kids with overlapping conditions, such as ADHD and depression, or Tourette’s and unstable mood.
I am happy to say that in the 15 years since I finished my fellowship at UC Davis, the therapeutic tools in child and adolescent psychiatry have grown in safety and efficacy. We are rapidly approaching the day of pharmacogenetic profiling and functional MRI mapping of brain structures and pathways underlying mental and emotional conditions. Nonetheless, the developing brain is so complex that clinical application of the neurosciences will take longer in child and adolescent psychiatry than in other branches of medicine.
Medication for kids with mental and emotional conditions has always been a controversial and complex issue, and child and adolescent psychiatrists are often at the center of the storm. Despite the controversy, I see kids for whom medication plays a vital role in improvement of their functioning at home and school. We do save lives, and treatment does help to stop self-destructive behavior and tragedies like adolescent suicide.
Child and adolescent mental health services in Sonoma County are provided by both the public and private sectors. Public services are offered through the county’s Mental Health Services Division. After my wife, Staci, and I moved to Santa Rosa in 1998, I worked as a child and adolescent psychiatrist with the county for five years. I saw firsthand how our county government endeavors to provide mental health services to a target population of kids with severe emotional disorders. I worked at the Children’s Day Treatment Center for two years before it was closed down. I also helped found a psychiatric clinic for kids with Medi-Cal at the Resource Team on Farmers Lane; that has since been closed down as well. The county currently has three child and adolescent psychiatrists on staff, and Medi-Cal kids are seen through its Youth and Family Services Section.
The private sector is divided between Kaiser and a handful of child and adolescent psychiatrists in private practice. At North Bay Behavioral Health, which Staci and I founded 10 years ago, our service delivery model emphasizes coordinated mental health care, access to service, and close ties to our referral base of pediatricians, family doctors and community therapists. The worst thing for primary care physicians is to refer into a “black hole,” where you send a patient to a specialist and then never hear a thing. To prevent this from happening, when we assess a child and family, we send a note to the referral source with an update on our findings and the progress of care.
Our practice includes in-house therapists, social workers and psychologists, all of whom specialize in children and families. Having in-house clinicians allows us to serve more kids and families through collaborative care.
One challenge to providing mental health care in Sonoma County is the lack of an inpatient facility for kids or teens. Luckily, hospitalization is an uncommon occurrence for kids when a higher level of outpatient care is available. While it is generally safer for kids to receive treatment in their home environment, sometimes inpatient care is the only option. Sending kids to inpatient facilities in Vallejo, San Francisco, the East Bay or Sacramento makes coordination of care with families and local providers more difficult.
Day treatment is a more helpful option than inpatient care. Kids with severe emotional or behavioral disorders often end up being placed by their schools in special educational settings after a lengthy process called the Individual Education Plan. Locally, there are two day-treatment facilities for teenagers: New Directions in Santa Rosa and Journey High School in Sebastopol.
In recent years, several child and adolescent psychiatrists have left Sonoma County, overwhelmed by the service demand. Despite the crisis in medical care, the constant closures of private practices and the flight of doctors, we have stayed in the community and built our practice. As a fourth-generation San Franciscan, I have strong family ties to Northern California. When you grow up here, it’s a hard place to leave.
E-mail: john_leipsic@hotmail.com
References
- Report of the Surgeon General’s Conference on Children’s Mental Health (January 2001).
- The President’s New Freedom Commission on Mental Health, Final Report (July 2003).
Dr. Leipsic, a child and adolescent psychiatrist, directs North Bay Behavioral Health, a group practice in Santa Rosa.
