Medicine, Mental Health and Child Welfare: "Three Different Worlds That Need to Amalgamate"

The past 50 years have witnessed a dramatic change in the morbidity and mortality of many (if not most) pediatric diseases. The primary driver for this improvement has been the billions of dollars invested in research by the National Institutes of Health and hundreds of not-for-profit advocacy groups that have raised awareness and money to support research, treatment, prevention, and advocacy for their cause. Child abuse and neglect is a glaring exception, with no significant improvement in mortality from physical abuse and neglect over the past 50 years. Furthermore, child protection in the U.S., which has been the responsibility of the state and county Child Welfare Departments, have been struggling for at least 30 years and have no data on the quality and outcomes of their services to children and families. This article discusses some of the past failures to address the issue, and suggests that for progress to be made, health, mental health, and child welfare professionals have to be able to work with each other in a way that allows child and families to be free of abuse and neglect. It builds on the recent efforts to embed mental health services and professionals in primary care practices. Public Significance StatementThere are millions of reports of child abuse and neglect in the US annually and millions of adult "survivors" of their own abuse, that are not getting the help they need to thrive. Compared to other health issues, progress has been negligible. This paper suggests some of the changes necessary in the Health, Mental Health and Social Services Systems going forward.