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Pediatricians May Fall Short in Treating Patients with Mental Health Conditions

A nationwide shortage of child psychiatrists has put much of the burden for mental health care on pediatricians, who feel ill equipped to tackle these issues.

March 24, 2017

Pediatricians are often expected to diagnose and treat mental health problems in their patients — despite evidence that they may not be well equipped to tackle these issues. A new report in Infectious Diseases in Children, published earlier in March, explores this issue in-depth.

The relative scarcity of child and adolescent psychiatrists leads many parents to see pediatricians for care. Currently, there are only about 8,300 child and adolescent psychiatrists in the United States — about 1 for every 9,000 children. The U.S. Bureau of Health Professions estimates that to meet the current need, an additional 5,000 psychiatrists will need to enter practice by 2020 — unlikely at the current rate, experts say.

In light of this shortfall, pediatricians have been expected to pick up the slack, with a 2015 study finding that 35 percent of children receiving mental health care saw only their pediatrician — only 26 percent saw a psychiatrist at all. But pediatricians often don’t feel comfortable doing this work, they report. A survey conducted by the American Academy of Pediatrics (AAP) in 2013 found that 65 percent of pediatricians felt they lacked comprehensive mental health training. Fifty percent said they lacked confidence when faced with a patient with mental health problems. This is especially concerning, experts say, since nearly 15 percent of U.S. children will experience a mental health disorder — most commonly ADHD, anxiety, or depression — at some point in their lives.

These problems aren’t necessarily new, experts say. But they’re coming to light more and more — mostly due to growing recognition of mental health issues in children.

“Pediatricians have always been the so-called ‘default provider’ — when the system is not working, the pediatrician ends up being left to pick up the pieces,” said Barry Sarvet, M.D., in an interview with Infectious Diseases in Children. “When these systems are not able to provide adequate support for children, mental health crises become more urgent and lead to a sense of frustration and desperation.” What can be done? For starters, adequate reimbursement — from both private and government-sponsored health-care plans — may motivate more individuals to pursue mental health specialties, said Julia McMillan, M.D. Currently, low reimbursement rates discourage some interested doctors from pursuing further training, she said. In the long run, the more child and adolescent psychiatrists, the better.

The key, however, may lie in better training for pediatricians in the short-term — accepting the current state of affairs and working actively to prepare pediatricians for the inevitable mental health patient. Training programs, like the Resources for Advancing Children’s Health (REACH) and the Post Pediatric Portal Pilot Project, help pediatricians become comfortable assessing and treating a wide range of mental health issues in children — including ADHD, bipolar disorder, and depression.

“Pediatricians certainly do not worry about treating pneumonia or otitis media, because they have been trained very well for these conditions and that training has been reinforced in daily practice,” said Michelle Macias, M.D. “Through programs like the REACH Institute, there has been an effort to help practices and individual pediatricians become similarly comfortable treating common mental health conditions.”

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