Introduction

Although changes in mental health care financing are occurring globally, little data are available on the effect this may have on access to treatment, treatment outcome, and services themselves. What is known is based on adult data; thus, the impact of health care reform on children and adolescents is largely unknown. To improve service availability and treatment of mental disorders for children and adolescents, we need to know more about the cost of treating childhood disorders, and the barriers to accessing that care. This begins with knowledge of the number of children and adolescents who ‘need’ services, and the proportion of those ‘in need’ who receive mental health services.

Assessing need

Need is defined in several ways: from receiving mental health care, to functional impairment, to meeting criteria according to standardized DSM or ICD criteria (Costello, Burns, Angold & Leaf, 1993). Estimating need based on service use requires: (1) a system of care that documents in a standardized way the symptoms that are experienced by children and adolescents; (2) valid data collection; and (3) a clear understanding of all service arenas used by children and adolescents. Knowing how to identify the repertoire of service agencies and providers in all regions of a country is one of the major difficulties of defining need as ‘use of services’. In the USA, services related specifically to children typically include those received through the social welfare office, and visits to a juvenile justice program, a counselor at school, a psychologist, primary care provider or a psychiatrist. Data show that approximately 1% of children receive mental health services in mental health settings (Burns & Friedman, 1990) and approximately 6% receive services related to mental health within the primary care and school systems (Costello, 1989; Horwitz, Leaf, Leventhal, Forsyth & Speechley, 1992).