Treatment Doesn’t Eliminate the Need for Ongoing Support


Treatment doesn’t always work as well as we would hope in the fallen, messed-up world we live in. Families need our support through every step of their journey.

Today, we’ll look at a feature of most common mental health conditions that is often overlooked…the propensity of symptoms to persist over time despite effective treatment.

When I started my child psychiatry fellowship a quarter century ago, I was quickly relieved of my misperception that kids were far less likely to experience chronic mental illness than adults.

While we see kids who “outgrow” their ADHD, master their social anxiety, overcome the effects of a specific trauma or remain symptom-free years after an episode of major depression, they’re the exceptions as opposed to the norm. Most of the kids I see in our practice experience conditions every bit as chronic as the diabetes, hypertension and heart disease managed by my med school classmates who went into internal medicine specialties.

My first attending physician as a resident in psychiatry at Cleveland Clinic went on to become a world-renowned researcher in the field of mood disorders. I remember sitting in a conference room hearing him say that “successful” treatment in our field was indicated by 50% or greater improvement in symptom severity on a rating scale that had been statistically normed and validated for the condition being treated.
Obsessive-Compulsive Disorder (OCD) is a great example of this…the typical kid who was classified as a “responder” in the FDA trials of medication for OCD got about 40% better following three months of treatment at the dose ranges employed for the study. I’ll tell parents that if we’re successful, their child/teen will obsess half as much for half as long with half of their current intensity. But if their son or daughter’s obsessive thoughts are especially intrusive or their compulsive behaviors sufficiently disruptive, they may still be miserable much of the time and the impact on family life may be unbearable.

Let’s look at kids diagnosed with Bipolar Disorder…more than 50% of kids deemed “positive responders” to medication in short-term studies that led to FDA-approval conducted at a major academic medical center relapsed within a year. Among the kids who relapsed, the benefits of their “effective” treatment lasted, on average for seventeen weeks.

Or teens with depression…In the “landmark” study examining treatment of adolescent depression, kids who received “combined treatment”…three months of medication combined with three months of cognitive-behavioral therapy (CBT) in our top academic medical centers-only 37% achieved “remission” of their depression and half of the “responders” continued to experience significant functional impairment from depression.

Or kids and teens with anxiety…in the “definitive” treatment study, 40% of kids receiving CBT didn’t experience a significant response. 45% of kids receiving medication alone failed to respond. Roughly one kid in five failed to respond to the combination of BOTH medication and CBT…administered by highly skilled clinicians in our best research centers! In the long-term follow-up study, more kids had relapsed than remained in remission among those who had been positive responders six years earlier.

Clearly, good treatment can help the vast majority of kids and families impacted by mental illness. But treatment doesn’t always work as well as we would hope in the fallen, messed-up world we live in. And families need our support through every step of their journey.

Rick and Kay Warren’s son presumably had access to the best mental health care available. According to the Centers for Disease Control, suicide is the third leading cause of death in the U.S. among persons ages 10-24, and the second leading cause of death (behind only motor vehicle accidents) in 25-34 year olds. These are serious illnesses. Lots of young people die.

How can churches (or individuals) help? Here are four ideas...

  • Give families the gift of presence…Isolation is an unfortunate byproduct of many of the more common mental health conditions we treat. Being present for those who are hurting in difficult times is an immediate expression of the love of Christ.
  • Offer practical help and support that meets immediate needs…Families of kids and teens are likely in need of respite…and you don’t need to wait for your church to launch a respite ministry to do it. On the other hand, there’s a ministry that many churches already have in place that can have a great impact…cheesy potatoes, anyone?
  • Don’t assume to understand God’s purposes when those around you fail to experience relief from suffering. See Job, Chapters 38-42. God is not pleased when we misrepresent Him to others in the midst of their suffering.
  • Take care of those serving in vocational ministry and their families. By virtue of what I do, I see a fair number of PK’s. Many of the conditions we’ve discussed are associated with a significant genetic predisposition. It’s the norm as opposed to the exception for kids with mental health issues to have parents with mental health issues, because of the interface between genetics and the additional strains mental illness places on the family. In every single ministry family currently on my caseload,  someone else in the family in addition to the child I’m treating is receiving mental health treatment. An added burden ministry families face (in addition to the stigma in the church at large) is the financial pressure of paying for treatment. Most ministry families I see blow through their entire health savings account well before the end of the year on the cost of outpatient mental health care or medication alone. The best mental health practitioners frequently opt out of insurance networks. I can’t imagine how a church that fails to provide adequately for the needs of those who devote their lives to preaching and teaching will be effective caring for those outside of the church.

Dr. Steve Grcevich is a physician specializing in child and adolescent psychiatry who serves as President and Founder of Key Ministry. He blogs at church4everychild.org and may be reached at steve@keyministry.org.

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