One in three children seek outpatient mental health care services from a primary care provider instead of a specialist, a new study shows. The findings highlight the potential for medical professionals to effectively treat mental illness by collaborating with each other — particularly amid psychiatrist shortages that make it hard for some Americans to get an appointment with a mental health provider.
Analyzing data from nearly 43,000 U.S. children between the ages of 2 and 21 within a three-year span, researchers at MassGeneral Hospital for Children in Boston found that 35 percent of children receiving mental health care in the last year sought help from their primary care physician. Smaller numbers, around 25 percent saw and 15 percent respectively, connected with psychiatrists or psychologists.
As child psychiatrists struggle to the meet the demands of the one in five adolescents who have a mental illness, primary care physicians have increasingly stepped in to provide health care. Dr. Jeanne Van Cleave, the author of the study, said that these doctors have helped filled a gap. “Primary-care physicians provide a good home for children’s mental health conditions,” Van Cleave told LiveScience.
Primary-care physicians provide a good home for children’s mental health conditions.
However, she added that making their input more effective would require more effective collaboration with child psychiatrists, psychologists, and social workers.
This approach fits into what’s been designated as the collaborative care model — an integration of specialized mental health services and primary care. It expands across the entire health care process, including diagnosis, treatment, surveillance, health communication, management, and support services. Those under care in this type of health care have more autonomy in their medical decisions, a feature that would more than likely attract those who have sought specialized mental health services after visiting a primary care doctor. Additionally, carrying out this model could significantly reduce Medicaid and Medicare costs.
The current childhood mental illness landscape provides an ideal opportunity for the collaborative health model. More than 10 percent of adolescents develop a depressive disorder before the age of 18. Traumatic life events and the stress of adolescent change can trigger mental health issues like depression, anxiety, and conduct disorder. In recent years, ADHD and anxiety have accounted for a large majority of the outpatient care that children receive.
Meanwhile, the psychiatrist population is dwindling, with nearly 60 percent of those in the field nearing retirement age. This has posed a problem, especially as more Americans become eligible for mental health care under the Affordable Care Act. Federal health officials say nearly 4,000 areas in the U.S. have a shortage of mental health professionals. Ohio has launched long-distance tele-psychiatry services and Texas legislators recently approved a loan payment program for psychiatry graduates who work in underserved fields.
Researchers argue that the collaborative care model would create more of an impact during a time when Americans are paying more for health care but faring worse than their counterparts in other countries. However, creating these multidisciplinary teams would require primary care providers’ willingness to cooperate, especially since they don’t have resources readily available for patients diagnosed with a mental disorder. A 2011 study published in the International Journal of Integrated Care suggested that the onus falls on physicians to reach out to key players of other disciplines committed to young patients’ mental wellbeing. When collaboration between physicians and their counterparts increased, roles became clarified and access to specialized care increased.
Such has been the case in the state of Washington, where more than 200 community health centers have implemented mental health integration programs. Since its 2008 inception, more than 35,000 people have received care in this framework, with practitioners using a patient registry to track patient goals and clinical outcomes. Care managers also have access to webinars about delivery of mental health care services in a primary health care setting. New York followed suit in 2011, receiving $250 million in financial support from the Centers for Medicare and Medicaid Services to use the collaborative care model in treating depression among primary care patients.
“New York is poised to fundamentally transform its Medicaid program into a national model for cost effective health care delivery. Thanks to the work of the Medicaid Redesign Team the State of New York now has a multi-year road map that points the way toward a program and system that are affordable and produce good outcomes for all New Yorkers,” a New York Department of Health report outlining changes to the state’s Medicaid program said.
Whether some semblance collaborative care model would work in other childhood mental health care settings has yet to be determined. The recent research didn’t include information about services provided by schools, juvenile justice programs, and child welfare agencies. It also didn’t record the number of children who may have a mental health problem, but don’t seek treatment.