NEW YORK STATE — There are no child and adolescent psychiatrists in Schoharie County, unless you count the psychiatrist who visits the county’s mental health clinic once a month, and Joe Patterson does not.

That’s why Patterson, the director of community services in Schoharie County, pushed hard to bring telepsychiatry to the county. Now families and children can talk to a child and adolescent psychiatrist at Columbia University in New York City using a camera and a computer.

“There’s a real dearth of child and adolescent psychiatrists,” he said. “The telepsychiatry program boosts our ability to do consultations. We want good outcomes for our kids.”

The telepsychiatry program, which aims to connect children in rural counties with child and adolescent psychiatrists, is run by Columbia University’s Division of Child and Adolescent Psychiatry Program and funded by the New York State Office of Mental Health. It is just one of the agency’s efforts to increase access to mental health services in areas where there’s a shortage of child and adolescent psychiatrists. The problem is particularly acute in rural communities and upstate.

Last week the Schuyler Center for Analysis and Advocacy in Albany sponsored a discussion on the statewide shortage of child psychiatrists. In a March paper, the organization made several proposals for increasing the number of child and adolescent psychiatrists in New York and described the shortage as “reaching crisis proportions.”

In New York, there are 24 counties with no child and adolescent psychiatrists at all and seven counties with only one. In the Capital Region, Albany County has 13 CAPs, Fulton County has none, Montgomery County has two, Rensselaer County has one, Saratoga County has 11 and Schenectady County has two.

One proposal entails establishing a training program for child and adolescent psychiatrists in Albany and expanding existing programs in Buffalo, Syracuse and Rochester. The Schuyler Center and New York State Conference of Local Mental Hygiene Directors have asked the state for $1.5 million to establish a child and adolescent psychiatrist training program in Albany and $2 million for the expansion of the existing programs. A likely location for the Albany training program is Albany Medical College, where Melissa Doyle, the college’s section head of pediatrics, is laying the groundwork for a program.

It’s been at least 15 years since Albany Medical College had a training program for child and adolescent psychiatrists, Doyle said. “We’re trying to respond to a national and local shortage,” she said. The main issue, she said, is funding; she is working with the Schuyler Center to obtain financial support through the state and local counties.

“It would be an incredible service to the community,” she said. “We would be able to provide services to children in the region.”

Because child and adolescent psychiatrist residents often stay in the areas where they train, the hope is that CAPs who train in Albany will remain in the Capital Region and nearby counties to practice.

Patterson was enthusiastic about the idea of a child and adolescent psychiatrist serving the Albany area. “That would be nice,” he said.

The New York State Office of Mental Health is making a concerted effort to recruit and retain child and adolescent psychiatrists and supports the Schuyler Center proposal, according to Stewart Gable, medical director of the Office of Mental Health’s Division of Child and Family Service. “We’re trying to encourage more people to go into the field,” Gable said.

Medical approaches

Child psychiatry has become much more biologically oriented, which is why it’s important to have well-trained child and adolescent psychiatrists prescribing and monitoring medication, Gable said. Child psychiatrists see children for a range of problems, such as Attention Deficit Disorder and more severe ailments such as bipolar disorder and depression.

“There’s an increasing recognition that mental health problems are very common and that treatment can avert severe consequences,” he said. “Early intervention is very important.”

At the state Office of Mental Health, the focus is on detecting emotional and behavioral problems early and setting up a treatment program before the problems grow more severe. If children do not receive treatment, “their ability to succeed in school is going to worsen, or it’s possible they’ll commit offenses and end up in the juvenile justice system,” said Lloyd Sederer, OMH Medical Director.

According to the U.S. Surgeon General, about 20 percent of children are estimated to have a mental disorder, with 5 to 9 percent of children having severe mental disorders, but nearly two-thirds go without proper treatment. While it is estimated that approximately 33,000 child and adolescent psychiatrists are needed to adequately treat children in the U.S., there are only 7,000 child and adolescent psychiatrists in the country. In New York, there are an estimated one million children with emotional, behavioral or substance abuse disorders.

The state also supports providing primary care physicians, pediatricians and nurse practitioners with additional training so that they can better identify mental illnesses and treat children who have them. These people often feel uncomfortable prescribing medicine to children with emotional and behavioral disorders, but with better training they might be able to provide support for children who lack access to a child and adolescent psychiatrist, Gable said. Albany Medical College is already looking at ways to enhance such training for students, Doyle said.

More children are in need of mental health services than ever before, although the Schuyler Center paper doesn’t know whether to attribute this to increased awareness of mental health issues or whether more children have mental health problems. “Whatever the reason for the increased need, it is real and staggering,” the paper says.

Training demands

Becoming a child and adolescent psychiatrist requires more training — four years of medical school, three years of approved residency training in medicine, neurology and general psychiatry with adults and an additional two years of training in psychiatric work with children, adolescents and their families in an accredited residence in CAP.

“We think the extra years of training deters people,” said Jenn O’Connor, a senior policy associate at the Schuyler Center. “There’s a lot of training, and I think that people are tired by the time they get through the training.”

The state’s new Doctors Across New York program should help, officials said. This program will provide physicians and clinics grants and enhanced reimbursement rates to encourage new primary care and specialist physicians — including child and adolescent psychiatrists — to establish or join practices in underserved communities. The idea is that these grants would be used to repay education loans, which would make it easier for doctors to take less lucrative jobs in more rural or urban areas.

Schoharie County launched its telepsychiatry program about six months ago. Several children and their families have received consultations through it; the Columbia child and adolescent psychiatrist meets with the child individually, then with the family and then with the mental health clinic’s treatment group. So far, the program has been used only for initial consultations, but Patterson hopes to use it for follow-up visits.

“We’re finding that families and kids are really appreciating it,” Patterson said. “We’re just like any county — we have kids with emotional disturbances.”

Schoharie County is a federally designated mental health professional shortage area; 1,600 communities in the U.S. have that designation.