Many children see primary doctors for mental health care

Primary care physicians play a large role in treating children in the U.S. dealing with mental health conditions, according to a new study.

The study, published in the November issue of Pediatrics, suggests that primary care doctors are the sole provider of care for one-third of children dealing with mental health conditions and for four in 10 children with ADHD.

“What we found essentially was that a fair number of children and young adults see a primary care physician for mental health conditions,” said Jeanne Van Cleave, M.D., assistant professor at Harvard Medical School and a pediatrician at MassGeneral Hospital for Children in Boston. “They also see psychiatrists, psychologists and social workers, but about half the time they saw a primary care physician as well.”

The study, which examined health care seeking behavior for outpatient mental health care by U.S. youth, aged 2-21, found that:

• 34.8 percent of children and young adults receiving outpatient care for mental health conditions saw primary care physicians only

• 26.2 percent saw psychiatrists only

• 15.2 percent saw psychologists/social workers only

• Almost a quarter (23.8 percent) saw multiple providers.

• More children and young adults dealing with attention-deficit/hyperactivity disorder saw primary care physicians only versus children with anxiety/mood disorders (41.8 percent vs. 17.2 percent)

“What it means is that primary care physicians are providing a lot of the mental health care for children in the United States and they appear to do that, at least in our study, because sometimes people often see only one provider, (or if they see multiple providers), the only person that is seen by many people is the primary care doctor,” said Van Cleave, a lead author on the study. “What that means is anything we can do to support the primary care doctor in providing mental health care will likely improve the quality of health care that children with mental health conditions receive.”

The study also found the children dealing with ADHD who saw a primary care doctor were more likely to be prescribed medications for the disorder than if they saw a psychiatrist.

“Why that is we weren’t really able to say with our study,” said Van Cleave. “Three out of four kids who saw a primary care doctor for ADHD received medication for ADHD while six out of 10 people who saw a psychiatrist did.”

Researchers looked at data from the Medical Expenditure Panel Survey (MEPS) from 2008-2011 to determine if children and young adults aged 2 to 21 were seeing primary care physicians, psychiatrists, and/or psychologists/social workers for outpatient care of mental health problems in the past year.

This study provides a broad overview of outpatient mental health care for children in the U.S. while other similar studies have looked at segments of the population or at one condition, Van Cleave said.

Researchers also compared the proportion of children prescribed psychotropic medications by provider type, according to the study.

Van Cleave said research has shown that there is a shortage of mental health providers for children across the country.

“What maybe should be recognized is that primary care physicians can be partners in caring for children with mental health conditions,” she said. “The ones that I know, and what we know from other research is that they are always willing and ready to work with other mental health providers to care for their patients collaboratively. That includes having regular conversations about patients, notifying each other when patients aren’t doing well, and exchanging medical records on a regular basis.”

Research has also shown that families embrace, and sometimes expect, collaboration between mental health and primary care providers, she said.

The article is available for free at http://pediatrics.aappublications.org/content/136/5/e1178