A mental health crisis among the nation’s youth was on the rise before the COVID-19 pandemic gripped the nation. As pediatricians and family physicians can attest, the pandemic only exacerbated the number of children who come into their office with mental health concerns, including anxiety and depression.
Making matters worse, every state in the nation faces either a high or severe shortage of child-and-adolescent psychiatrists. Consequently, pediatricians and family physicians continue to play an integral role in the early detection, intervention, and treatment of pediatric mental and developmental health symptoms and disorders.
“Those of us who are used to identifying and then referring on, just find we can’t really do that,” said Joan Jeung, MD, clinical professor of pediatrics at University of California, San Francisco School of Medicine. “That means primary care really has to step up to the plate. There is no way we are going to be able to address this critical health care need for our patients unless we increasingly move into spaces that the specialists had inhabited before.”
Dr. Jeung and Arwa Nasir, MD, division chief of general pediatrics at the University of Nebraska Medical Center, took part in an AMA-hosted webinar, “Tackling the Youth Mental Health Crisis,” part of the “Overcoming Obstacles” series presented by the Behavioral Health Integration Collaborative.
The pediatricians highlighted these four ways that family doctors, pediatricians and others can promote healthy mental developmental, identify and intervene with children and adolescents facing mental health challenges, and how physician practices can leverage integrated behavioral health to better address kids’ mental health needs.
Prevention and promotion
Physicians can give parents the tools they need to be able to help their kids at home. For example, Dr. Nasir said that research has shown that a strong, stable, loving relationship with at least one adult is probably the single most important factor needed to build good mental health in children and adolescents.
Such a relationship helps kids feel they have value in life and can prevent isolation and loneliness. She said physicians can encourage parents to have supportive relationships with their children. That means spending one-on-one time with them without distractions. For example, Dr. Nasir advises parents to spend time each day cooking and preparing a meal together, have a device-free dinner or engage in an activity that the kids enjoy.
“We pediatricians always work through parents. We are partners,” she noted. “We do not expect to do everything for a child with diabetes. We diagnose, we treat and we send them home and the parent will have to do a big part of the work. Same thing here.”
Screening and identification
There are numerous screening tools that physicians can administer, including during well-care visits, to gauge kids’ anxiety, depression and suicidal ideation, among other mental and developmental conditions. When leveraged with behavioral health integration, physicians and their care teams can be empowered to use these scores, combined with the patients’ history, to further assess the potential severity.
Initial management
Management decisions will depend on the severity, with the most severe cases being referred to a mental health professional with more specialized training. For mild cases, physicians can recommend a healthy diet, good sleep routines, exercise, mindfulness, joining peer-support groups such as sports teams or other nonathletic-oriented clubs for social connections. They can then look to schedule a follow-up visit with the patient in a few weeks to check in and further evaluate potential next steps.
Treatment
For more moderate to mildly severe cases, physicians can consider treatments such as cognitive behavioral therapy and medications if deemed medically necessary. For those in need of additional education, the American Academy of Pediatrics offers several mental health training initiatives.
Meanwhile, the National Network of Child Psychiatry Access Programs are also available in several states to connect physicians with real-time consultation with child and adolescent psychiatrists including education, resource referrals, and care coordination.
