David Satcher, M.D., Ph.D.
Assistant Secretary for Health and Surgeon General
Office of Public Health and Science

Tuesday, September 19, 2000

[This text is the basis for the Assistant Secretary for Health and Surgeon General’s oral remarks. It should be used with the understanding that some material may be added or omitted during presentation.]

Good Afternoon.

I'm Dr. David Satcher, the Assistant Secretary for Health and Surgeon General. I have here with me four experts: Dr. Steven Hyman, Director of the National Institute of Mental Health; Dr. Bernie Arons, Director of the Center for Mental Health Services; Kelly Kelleher, a primary care physician and pediatrician; and Senora Simpson, a grandmother and mother who speaks on children's problems from her own experience.

This meeting grew spontaneously out of a series of other meetings and  reports— notably the Surgeon General's report on mental health and the White House Conference on Mental Health. This meeting is exceptional for its participants: clinicians, researchers, parents, advocates, and teachers—the hands-on experts. Our science, our professional skills, and our humanity have come together to make a powerful force to improve the diagnosis, treatment, and recovery of adults and now children and adolescents with mental illness.

As Surgeon General I cannot create programs, but I can bring experts together to create a national agenda and with the help of all involved and, I might add, the help of the press, we can highlight some of our Nation's major health problems and set the stage for new programs or, in some cases, major course corrections in current programs. 

Together over the past 2 years, we have brought suicide, the lack of services for minority groups, and the issue of mental health to the attention of the Nation. This meeting is perhaps the most important of all these meetings as it focuses on our children. As Dan Offord, one of our speakers said: "We have children who are casualties." They are casualties before they reach school age. Older children are dropping out and are lost to our society. 'The suffering is enormous.

Dan Offord, one of our speakers, pointed out that 72 percent of 19 year olds with behavioral disorders had childhood disorders. And 85 percent of children aged 3 to 5 do not receive help they need.

We have stressed the need for evidence-based programs during this meeting—that is a way of saying we need to use what we already know and learn fast what remains to be understood. 

We know medications and behavioral therapies can provide effective help to many children. We know this approach is even better when it involves parents, teachers, and all others involved with a child.

We need more information about most medications for children. In most cases, medicines are prescribed based on the clinical experience of doctors rather than based upon clinical studies. In most cases, we do not have the information we need about the long-term effects on 4-year old or 6-year old bodies. However, the effects of not treating mental illness in children are abundantly clear.

We will be convening a small research-based workgroup on medications and young children and the results of that meeting and this one will be released as soon as we can write the report.

We have heard from parents and children and teachers and doctors and scientists during this meeting—all experts.

I'm speaking to you as deliberations continue, but we are already seeing areas of agreements and even recommendations and I would like to share these with you.

• We need a broad system to improve the identification, diagnosis, and treatment of children with potential mental health problems. And we need to remember that many people—parents, primary care providers, teachers—may play a role in pointing to a problem.
  

• We need to learn from the field of cancer and its life saving "five warning signs" and create a simple set of warning signs for problems with kids. This information needs to be distributed widely to parents, the general public, and professional groups.
  

• Preparing teachers and schools to be ready for children and ready to teach. We are doing a better national job at teaching children academic skills reading and writing. Now we need to focus as well on social and emotional issues. Teachers need information about behavioral and emotional issues and how to help children in trouble.
  

• We invite the primary care medical providers to develop primers for their offices that tell the parents what to ask and tell the provider what to query. Right now doctors think they are screening for these problems and parents think they are not asked about problems.
  

• Money. Money should follow need, not limit and dictate services that are unresponsive to children's needs.
  

We, perhaps, can wait for years to develop the best programs, but these children need programs tomorrow; they should be in place when their mothers and fathers seek help, when their teachers are mystified, when their primary care physicians look for specialists to help them make decisions. 

There is broad evidence that we lack a unified infrastructure to help these children and many children are falling through the cracks. Too often children who are not identified as having mental health problems and who do not receive treatment enter the Juvenile Justice system and end up in jail.

I would now like you to hear from our other participants.