Training Future Physicians to Treat Mental Disorders in Children

• By School of Medicine
• May 7, 2020

It’s estimated that one in six children in the United States has a treatable mental health disorder. Sadly, nearly half of all these children will go without treatment. Mental disorders in children can have serious consequences and can impede a child’s healthy transition into adulthood. Texas Tech University Health Sciences Center (TTUHSC) is working to solve childhood mental health challenges by providing medical training and services to help children in need.  

At the heart of this initiative is the Center for Superheroes, the only mental health center in the West Texas-Eastern New Mexico area that offers comprehensive medical, mental health, behavioral health and developmental services for victims of childhood trauma and their families and is 100% committed to delivery of evidence-based treatments for this population. The clinic takes a more holistic, integrated approach to mental health. 

Michael Gomez, Ph.D., a Licensed Psychologist at the Center for Superheroes and Assistant Professor in the Pediatrics Department at TTUHSC, explains that often physicians are seen as either being “above the neck” or “below the neck” doctors — and traditionally the two rarely meet. “Integrated, comprehensive care says that there's not physical health or mental health, there's just health,” explains Gomez. An Integrated Care (IC) approach is really about everyone on a health care team working in tandem when it comes to patient health.

Many child psychiatric disorders, including bipolar disorder, anxiety and depression, are in fact treatable with this integrated approach. “Mental health care is health care,” says Gomez. “When families and doctors think about it that way, other doors open up that may have been closed previously.” 

Moreover, research has shown that medications and medical procedures are more effective when the distinction between physical and mental health is eliminated. “The University of California, Los Angeles did a meta-analysis a couple of years ago showing that it's less expensive to have health services with therapy instead of separating mental health and physical health,” says Gomez. He goes on to explain that other medical centers are also seeing similar results after integrating mental health care. Outcomes for children are better, remissions are faster and costs go down when all of the medical professionals are working as a team. 

Many health care professionals today view mental disorders, even those in children, as being a uniquely specialized area of medicine. This perception can often be traced back to a lack of awareness training and a lack of focus on mental health in medical schools. Professional associations, such as the American Medical Association and the American Academy of Pediatrics, along with medical schools, are beginning to recognize the problem and are working to broaden and improve training in mental health issues for all future physicians. 

TTUHSC is leading the way in treating child psychiatric disorders by embodying this model of care in their own clinic and in their medical training programs. From their very first year at TTUHSC, students are taught the importance of mental health to a patient’s overall wellbeing. 

Training Future Physicians at TTUHSC

TTUHSC’s schools and staff, including mental health specialists like Gomez, strive to teach students the importance of effectively treating mental disorders in children. “In terms of training, we are very proactive. If you're a medical student, you're going to get training on mental health. It's not going to be additional,” explains Gomez. 

To accomplish this goal, TTUHSC’s staff is working to integrate mental health care into many areas of medical study. Students of Family Medicine learn how to screen for common child psychiatric disorders. The School of Nursing trains students (specifically Psychiatric Mental Health Nurse Practitioners PMHNPs) in an integrated, trauma-focused cognitive behavioral therapy (TF-CBT) model. “All of this shows a very strong commitment to health services and a better quality of life not only for our kids but also for people struggling with mental health challenges,” says Gomez.

A Lifetime of Care Equals Lasting Benefits

Treatment for mental disorders in children can have lasting effects far beyond their immediate health. Studies focusing on childhood adverse experiences have found that if all childhood trauma could be taken away overnight, it would have an immense impact, even into a patient’s adult years. And it would have an equally great impact on public health and community well-being. Psychiatric disorders like depression, suicide, alcoholism and drug use would all decrease. 

“If you get rid of childhood trauma, you get rid of your halfway houses. You empty out prisons, you get rid of your methadone clinics, dialysis clinics, and diabetes clinics,” says Gomez. Other researchers have worked to quantify the cost of childhood psychological disorders and found that it costs affected families an average of $210,000 in the United States. “That's the actual cost of unaddressed traumatic stress which leads to unaddressed mental illness. We usually catch people suffering from untreated mental illness in the legal system or later down the road in a dialysis unit.”

The Importance of Caregivers

Like many child psychologists, Gomez’s time is split between working with children and working to educate caregivers. “We tell them the best thing you can do for your kid is to be healthier in your own functioning. Kids are little emotional barometers; if you want to know how a family is doing, just look at the kids and they'll tell you immediately.”

Evidence-based treatment approaches are based on giving caregivers the tools they need to manage their own stress, as well as help their child. Children’s mental health can hinge not only on environment but also on the support system available to a child. Even when children experience a traumatic event, such as war, if the family is still trying to protect the children and the children feel that care and support, it can insulate them from some of the impacts on their mental health. 

In large part, spotting the signs of mental disorders such as attention issues, anxiety, or depression in children comes down to the caregivers in the child’s life. Often, it is a matter of identifying regression patterns or sudden changes. If a child who was fully potty-trained suddenly goes back to wearing diapers, this can be a red flag. “We tend to tell parents to look for three things: frequency, duration and intensity. How often is it happening in the day or week? How long does it happen? And then how intense is it on a scale of one to ten? If it's lighting up on all three, that's way outside the norm,” says Gomez. 

Educating Physicians to Help Spot Mental Disorders in Children

With the advent of increasing mental health awareness in recent years, pediatricians and other primary medical providers are realizing they need more education to properly treat child psychiatric disorders.  Many have even started taking it upon themselves to perform in-office checks to help get children the care they need. A growing part of a child psychiatrist’s job is to help spread this education to more health providers and parents so they know the signs to look for in children. 

The staff at the Center for Superheroes train pediatricians, nurses, and family medicine physicians to determine what is “normal” behavior and what is not during a checkup. Gomez and other child psychologists are also working to increase screening standards for ADHD, autism, anxiety, and depression in children. Their work has resulted in the development of many free toolkits that providers and parents can access to learn more about spotting the signs of child psychiatric disorders. “There's even a series published by the American Psychological Association on how to talk to kids about medication and depression. We don't think parents should have to generate these conversations on their own because they have enough to do. So we provide the tools to demystify how to have this conversation with their children,” says Gomez. 

Open conversations and education are becoming increasingly important as the occurrence of childhood psychological disorders, such as autism and depression, are increasing. “When I talk to physicians, I tell them one of the best things they can do is provide calm to the family. Being that calming presence can then allow that conversation with the family or child to take place,” explains Gomez.

Options Outside the Clinic

Working as a child psychologist is not limited to the clinic, though. While a large portion of Gomez’s work is at the Center for Superheroes, he also teaches classes and conducts research on child psychiatric disorders. He is also very involved in public policy, helping on court cases, and is working to improve the mental health care system. 

“If you have an interest in pediatrics or child mental health, you don't have to be a therapist or a physician, there are so many other things we need. I actually talk a lot to people in business and law, because we need those people to be pediatric trauma-informed. It can be hard to find somebody who has an MBA but also knows a lot about child mental health. When you find them you don't let them go,” explains Gomez. 

Childhood mental health specialists are needed in a multitude of different situations. When a court decides a child needs therapy, it is important to have an educated resource the court can go to for help making decisions on what kind of therapy would be best for each situation. 

There is also a large need for knowledgeable mental health specialists to help with public policy and legislative issues. The Mental Health Parity Act protects a patient’s right to mental health services and states that providers should be able to reimburse depression treatment at the same level as treatments for physical ailments like asthma. The American Psychological Association has a team of attorneys in Washington D.C. trying to ensure continued support and enforcement of this act. 

There are additional professional options beyond legal matters. Childhood psychologists also work closely with statisticians to analyze raw research data to make sure treatments are safe and effective. 

The Real Superheroes

Being a child psychologist can come with difficult challenges, especially when treating children who have experienced horrific traumas. “What I tell students is that there are two reasons you may not want to do this job. The first one is you just don't want to do it, or don't like it. And that's fine. The second one is burnout. As educators, we want to take burnout off the table. We give students very specific training on things beyond self-care to help prevent this. We want to give them strategies that are intentional and that are integrated into their day-to-day (vs. telling them to take a bubble bath after work). Because if you're not having fun doing this job, you're probably doing it wrong. And the day I stop thinking that this is a really exciting, fun and worthwhile job, I'll stop doing it,” states Gomez. 

When asked about his own initial interest in becoming a child psychologist, Gomez explains that he worked in a few different in-patient hospitals with children before he knew what he wanted to do. One day, a hospital director told the volunteers that the children were beyond help, the best they could do for them was to give them a slightly better level of care. 

“I thought, you know what, you're right, I don't know what I'm doing and I need to get more training. But are these kids philosophically beyond help? We're going to have to agree to disagree. I just don't believe that. Our mission statement for the Center for Superheroes is that from the dirt and ashes comes trees and fruit; there is no hopeless case. No child will be left in the darkness alone,” says Gomez. “I tell therapists before they go into their first solo treatment session to remember the child survived the trauma; they will survive the recovery and so will you.”

Gomez says even though he hears many terrible and heartbreaking stories, he continues to draw inspiration and motivation from the strength that he sees in these children. 

At the Center for Superheros, the children are the real superheroes. “I tell kids we're called the Center for Superheroes, and what superheroes have in common is that all of them have had something hard happen to them, usually when they were a little kid. And that's why I know they can do it. Batman and Spider-Man fell down a lot, and Superman always didn't know what to do. But they all figured it out. I tell them, you are these superheroes.”

If you would like to learn more about the Center for Superheroes, you can visit their website. If you are interested in learning more about TTUHSC’s medical programs, visit the Texas Tech University Health Sciences Center School of Medicine program page, email us at: somadm@ttuhsc.edu or speak with the School of Medicine Office of Admissions at (806) 743-2297.