Logistical Barriers, Incomplete Approaches and How Black Box Labels Impact the Ability to Address Mental Health Needs of Children

Depending upon the research you cite, between 10-15% of children in the United States have a mental health need.  One of the areas that is sharply rising is anxiety disorder, but the overall trend line is also ascending year after year.  In an attempt to better address the mental health needs of students, some Wisconsin school districts now allow mental health providers to set up satellite clinics within their school buildings.  Kimberly and Kaukauna currently have this practice and Hudson and Edgerton are considering it for the upcoming school year.  The Beloit School District has recently hired full-time licensed mental health therapists. 

The slide below highlights some of the most significant issues facing the provision of adequate mental health services to children in Wisconsin (I will venture that these issues generalize to most states). 


  • Demand far outstrips available services.  There is a severe shortage of child psychiatrists nationwide.
  • Rural areas have virtually no mental health therapists.
  • Prescribing mental health medications to children is a dynamic art versus a proven science.  Few mental health medications are clinically trialed on children, thus physicians provide calibrated doses and often multiple medications to attempt to find a balance that yields benefit to the child.  The ongoing problem is that as the child is growing, his/her metabolism is changing, and what was effective today might not be effective in a month.
  • Kids are sometimes prescribed mental health medication with BLACK BOX LABELS — a BLACK BOX LABEL is the strongest warning the FDA requires, and signifies that medical studies indicate that the drug carries a significant risk of serious or even life-threatening adverse affects.
  • Since 2004, the FDA has required that BLACK BOX LABELS be placed on all antidepressant medications warning they may result in increased risk of suicidal tendencies in children and adolescents.
  • Antidepressants combined with psychotherapy represent the most effective course of treatment.  However, many children are medicated without adequate concurrent psychotherapy – and in some cases, they are ONLY medicated – so the underlying issue is masked by the medication.  It’s like spraying primer on a rusty metal porch chair.  Just because you cover the rust doesn’t mean that it’s not present – and when you stop the periodic application of new coats, the rust will creep through…

U.S. Food and Drug Administration. “Guidance for industry. Warnings and precautions, contraindications, and boxed warning sections of labeling for human prescription drug and biological products—content and format”. Retrieved 2010-02-21. 

National Institute of Mental Health, Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers.”