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Whether it is a kiss on the forehead each night at bedtime or a slap in the face for talking during a television program, childhood memories can last a lifetime.

So can other mental health problems related to a wide range of causes if left untreated, according to mental healthcare professionals in southwest Minnesota.

A recent surgeon general's report claims one in 10 children nationwide suffer mental illness to a degree that causes some level of impairment, yet only about one in five children needing help get it.

Meanwhile, the World Health Organization estimates that by the year 2020, childhood neuropsychiatry disorders worldwide will rise proportionately by more than 50 percent to become one of the five most common causes of morbidity, mortality and disability among children.

Southwest Minnesota is likely no exception, say mental healthcare professionals, who see increasing numbers of children with serious mental health issues, from attention deficit disorders and schizophrenia to depression and anxiety. They attribute part of the increase to better awareness and to more children having problems.

Yet a number of factors prevent youngsters from getting help, including stigma attached to treatment, the cost and a lack of resources, they say.

"I think care has gotten worse," said Dr. William Knoflicek, a clinical psychologist with the Southwest Mental Health Center. "We went through a time when children had much better access to hospitals and residential treatment settings. Now, we've gone in the opposite direction, and they have to be extremely dangerous to themselves and others before they can be admitted to a hospital. There just is not the kind of funding available to do the kinds of things that are necessary."

Money is going toward intervention in both rural and metropolitan areas, but in some cases, these efforts are misguided, Knoflicek said.

"There are children that need more intense treatment than is being funded," Knoflicek said. "Some children really cannot get better at home, and that needs to be said."

Increased drug use among youths is contributing to more emotional and learning problems, Knoflicek said. So are heredity, and mothers smoking and drinking during pregnancy.

"Needless to say, to the extent that any kind of family instability, abuse, that kind of thing has increased, it's going to clearly affect children. And I think that probably has increased some," Knoflicek said.

Some parents reject therapy for their youngsters because it makes them uncomfortable, Knoflicek said.

"In general, the culture here is not very comfortable and sophisticated about emotional issues," Knoflicek said. "People don't talk about how they think and feel. When you talk about children with mental health issues, you're talking about how they think and feel, so it isn't very popular.

"People are more comfortable with what they and other people do. If you listen to what people say, very often what they're relating is stories about what they or other people do -- it's behavior, not what goes on between somebody's ears."

Other parents simply cannot acknowledge anything is wrong, Knoflicek said.

"That's somebody they love, so they don't want them to have any troubles, and if their children do (have troubles), they don't want to admit it," Knoflicek said.

And when parents do seek help, it isn't always available, Knoflicek said.

Short supply

Lac qui Parle County searched for more than a year for someone to supervise its in-school day treatment program, which was in danger of ending as a result, said Martha Christensen, supervisor and family therapist with the Greater Minnesota Family Services.

"And we're the only program around for miles," Christensen said. "It's hard to woo people to the country."

Child psychiatrists and psychologists are in short supply in general, and rural areas lack the finances and amenities to compete with larger cities, Christensen said. She commutes more than an hour to and from work.

Consequently, waiting three to four months for a doctor's appointment is common, and treatment continuity can suffer as mental health professionals revolve in and out of the region, Christensen said.

"You're really 'bandaiding' a lot," Christensen said.

Family problem

"A lot of mental illness runs in families," Christensen said. "It's a learned behavior. There are a lot of adults that have mental illness that are raising their kids the best that they can. They don't see the problem in the child because they have the same thing."

As a result, social workers try to work in homes with entire families rather than focusing simply on a single child, she said. Early home intervention has gained support in the last several years.

"Most of the families are very accepting of the help," Christensen said. "And then there's that other 25 percent that is very resistant, not because they don't want the help, but it's pride, or they have status in the community."

People tend to lose anonymity in small communities, which prevents some parents from seeking assistance and some children from wanting treatment, Christensen said.

"I have parents that have mental health issues," Grace Horgen, a licensed mental health social worker in Rock County. "They don't have the ability to take care of themselves, let alone children."

These parents often fear loosing their children if they seek assistance, she said. The reverse is generally true, and Rock County coordinates efforts to work with both families and individuals in families.

"The most helpful thing is to be totally honest and say you would do yourself and your children some good to get some services because you're less likely to have trouble with agencies like ours if you get some help," Horgen said. "It's harder for adults to change their pattern of behavior, but I have seen just huge, huge changes for the better with children when they get services."

Privacy is a big issue, Horgen said. However, only parents with good health insurance can afford the luxury of going to doctors in larger cities.

"Many of the people that we work with have medical assistance and don't have those kinds of resources," Horgen said. "They're limited to using the local mental health centers or family service agencies."

Stigma

Advertising on television is helping to normalize some depression and anxiety medications, but reducing stigmas surrounding psychiatric care needs more work, Gloria Sabin, clinical director of the Western Human Development Center, Inc., said.

"(Advertising) impacts the parents who make the decisions about seeking services for kids," Sabin said.

More often, parents try to fix a problem in a way that is less stigmatizing, Sabin said.

"There's this pioneer philosophy of I can do it myself, and I'll pull myself up by my bootstraps," Sabin said. "We're not thinking that when it comes to cancer and pneumonia because that's something that you supposedly don't have any control over. There is a faulty belief that you have control over your own mental health and you have to fix it.

"Therefore, if I go to ask for help, it means I've failed in fixing what I'm supposed to be able to fix and what I caused. That's wrong. We have multiple stressors; we have different limits built into us."

The mental health of children and parents are directly related, Sabin said.

"Parents need to deal with their own baggage and their own experiences that have left some scars so that they can give an emotionally healthy environment to their children," Sabin said. "One of the approaches parents take is 'fix this kid.' We know that the kid in some ways is reflective of some of the dynamics at home, so we would prefer to fix families than to fix kids.

"I've had kids sit in my office and their jaw kind of drops when I say this isn't your fault, you're having a lot to deal with. They just feel real relieved to not be carrying all that responsibility."

As area drug use rises, Sabin is seeing more teenagers with psychotic disorders triggered by the chemicals. Younger children generally come in with developmental disorders caused by some trauma.

How a child reacts to treatment depends in large part on how parents broach the subject, Sabin said.

"You don't need to talk about taking them to a 'shrink,' you can just say let's talk to somebody about this," Sabin said. "The parent can certainly pave the way for the children to feel comfortable about the visit."

The earlier children get help the better, Eugene Bonynge, CEO of Woodland Centers said.

"There is a general societal movement to identify issues earlier so they don't become huge issues later on," Bonynge said.

The cost

As more children get treatment, services feel the strain, Bonynge said.

"It's quite clear rural areas have a much harder time not only recruiting, but retaining mental health professionals," Bonynge said.

At the same time, reimbursements for mental health services have been flat-lined for a number of years, he said. To keep and lure professionals, counties often need to kick in money to make up for poor reimbursement levels.

"It's just now beginning to improve some," Bonynge said.

So is the availability of doctors, he said.

"For years it was totally impossible to get child psychiatry and very difficult to get adult psychiatry," Bonynge said. "Now, it's to the point where it's only very difficult to get child psychiatry and it's just getting tolerable to get adult psychiatry."

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