Monday, October 19, 2015

Who Is Seeing the Children and Teens with Mental Health Issues—and Who Is Doing the Prescribing of Psychotropic Medications?

By: Lewis First, MD, MS; Editor-in-Chief     

          We know that there is a critical shortage of mental health services for children and teens in this country, such that primary care providers (PCPs) are called upon to often diagnose and in turn treat and follow these patients because of lack of access to psychiatrists and even psychologists and social workers.  
         So just how often are these children being managed by a PCP?  Anderson et al. (doi: 10.1542/peds.2015-0807), in a study being released this week, used a nationally representative data set to determine if children and teens from 2 to 21 years are seen in the outpatient setting for their mental health issues by PCPs, psychiatrists or psychologists and social workers and who is prescribing psychotropic medications for these patients.  More than a third of children in this database were being seen by PCPs only which may or may not surprise you.  What won’t surprise you is that more than 40% of children with attention-deficit hyperactivity disorder (ADHD) were only seen by a PCP.  These numbers may be increasing rather than decreasing as the mental health issues we uncover in our patients rise, and the mental health work force stays about the same or even decreases in the years ahead. 
How does your practice compare to the results shared in this provocative study?  What do you suggest the AAP might do to help remedy the situation? Should pediatricians be trained to prescribe psychotropic medications that go beyond an ADHD regimen more than they are currently learning how to do?  We want to know how you are dealing with the mental health problems in your practice through your response to this blog, sending us an e-letter or posting your comments on our Facebook or Twitter pages.

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