In the last dozen years, I have been a part of a University of Kentucky outpatient center where we assess families and children who have open, substantiated cases of abuse or neglect.
A typical case would be a five-year old child, with a younger sibling, referred to our clinic after being placed in a number of different foster homes, following abuse and neglect by the mother, who was unmarried to either of the fathers of her children.
She had been minimally compliant with the case plan of the Kentucky Cabinet of Health and Family Services, often missing professional appointments, as well as supervised meetings with her children.
The mother, raised in rural Kentucky, was the victim of regular physical and sexual abuse from ages 3 to 14, at which time she told a teacher of her experiences and was placed in foster homes until "aging out" at 18 years.
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She had no further contact with her family; she lived in a trailer, received disability income only and had few supports from church or neighbors. She had abused and neglected both her children.
In Kentucky, during 2010, there were 18,332 children who were victims of abuse or neglect. We know how to identify children at risk. We know the treatment they need. Yet we are not doing either.
Less than 10 percent of our mental health dollars are being spent on the treatment of children aged five and below. That means that 90 percent of our money is being spent on treating children who have early life experiences and symptoms, which may have been preventable.
The economists tell us that every dollar we spend on mental health in early childhood saves us $17, along with lots of heartache, pain and sickness.
How did this happen?
We are a society that does not value children. There are few supports for mothers. Neighbors were aware of the mother's abusive and neglectful behaviors, but said nothing to her or officials. She was left to deal with her children and history alone. No one understood how her early experiences with her own mother shaped her abusive behavior.
She had tried to get help from a local mental health agency, who saw her once for her depressive symptoms and gave her prescriptions for medication. Few understood, nor felt any compassion for this mother.
Also wrong is our training of most professionals. Often our training does not emphasize the importance of understanding the causes of a person's behavior. Rather, we tend to train mental health professionals to look at symptoms, (e.g. depression) and then treat the symptoms, having little interest in understanding causes.
When I was practicing general medicine in Kansas, I was working in an emergency room on a Sunday evening. A mother brought in her 18-month old boy who had been "limping all day." He was limping, but I did not know the cause. We did a complete physical, paying special attention to his hip, knee and ankle joints. There was no redness, tenderness or swelling, I ordered an X-ray, which was normal. Then I got more sophisticated blood tests, which were also normal.
As I was helping the mother get the youngster dressed, I was explaining that I did not know the cause of his limping, so I didn't know what to suggest, and that when her pediatrician's office opened in the morning, she might contact them to see if they could figure out the cause. As I was telling her this, I had trouble putting on the boy's shoe. I reached inside and pulled out the tin soldier which had been in his shoe, the entire day.
The object of this story: Once we understand the cause, the solution was easy. Sometimes our trainees do not comprehend the importance of understanding the causes of symptoms.
Some of this is the fault of drug company advertising, marketing and advocating and our allowing them to influence our medical practices and behaviors.
Another cause is the emphasis on the bottom line, and the income-producing ability of seeing a large number of patients, in a short time, by prescribing medications which address symptoms only.
To understand causes takes time, and time is money. Insurance companies love the short medication visit, as it is cost effective in the short run. In the long run, we know the importance of understanding causes and the devastating effects of parental behavior on the developing child.
So, what can we do? We can:
■ Begin to change from a society which cares little for the consequences of abusive and neglectful parenting, to an aware, caring society. We can do this by modeling appropriate behavior and getting legislators to understand the effect of budgets and legislation on children. We can care about our neighbors across all social, economic and racial barriers.
■ Pay early childhood educators a salary which is commensurate with the importance of their jobs.
■ Fight the effects of drug and insurance companies' emphasis on the bottom line in dealing with the problems of people.
■ Offer training experiences in which the trainee gets taught the importance of understanding causes of problems and knows how to treat them.
Unless we begin, as a society, to do some of these things, the numbers of abused and neglected children will continue to rise.
I recently did a two-hour training to professionals on the subject of the mental health of children.
One member came to me afterward and summed it up perfectly. He said, "So you are saying that we need to love one another."
I agreed, enthusiastically.
About the author:
H. Otto Kaak, M.D., is professor of child and adolescent psychiatry, pediatrics and social work at the University of Kentucky.