Integrating mental health in the comprehensive care of children and adolescents: prevention, screening, diagnosis and treatment

© Pediatric Medicine. All rights reserved. Pediatr Med 2021 | http://dx.doi.org/10.21037/pm-21-36 The mental health of children and youth is an integral part of overall health and is a necessary cornerstone for lifelong well-being (1,2). For too long physical and mental health have been seen as independent of one another and the latter has been considered less important. In part, the past focus on physical health has been a reflection of the high mortality rates associated with infectious diseases and the primacy of improving survival, but as mortality rates have generally decreased, there has been increasing attention to helping children to thrive and consequently to the key role of mental health in their short and long-term well-being. These factors are fundamental to the genesis of our undertaking this special series of Pediatric Medicine. We did so with an eye toward focusing on the need for a comprehensive and global view of the status of children’s mental health. This series was conceptualized prior to the advent of the world-wide COVID-19 pandemic and the calls for social reckoning that have dominated the United States and many other countries facing racial, class, gender, and ethnic discrimination and violence. Acknowledging these seemingly unrelated global events is relevant because of their broad and sustained impact on the mental health of children (3-6). In the first instance, the pandemic has created particular conditions such as the closure of schools, the escalation of economic hardship and increased social isolation that have aggravated the socio-emotional stress borne by children and their families. Additionally, the recent pandemic of COVID-19 produced a keen appreciation of the extent to which mental health issues have intensified for children who are sequestered, often in tight enclosed spaces, or those who suffer the trauma of family illness and death, as well as other associated negative consequences of the pandemic. In the second instance, the outcry for social justice has unsurfaced long-standing conditions that reveal fundamental structural inequities, racism and stigma that impact the well-being of children (7,8). This is significant because racism/classism/ gender biases have been increasingly recognized as critical sources of psychological trauma affecting the mental health of children. At times these biases lead to recognizable psychiatric diagnoses such as post-traumatic stress disorder as well as poor health outcomes such as anxiety, depression and suicide (9,10). Myths and cultural attitudes have accompanied discussions of mental health for generations. It is notable that while these are ubiquitous, they differ across communities both in the degree to which they are recognized and in the ways with which they are approached and dealt. The stigma associated with mental health issues is prevalent in most communities and countries and significantly complicates the discussion of mental health in an international framework. One might legitimately ask why consider the mental health of children now. First and foremost, the reason is to ameliorate the current suffering of children, which we know Editorial