Pediatric Nurse Practitioner, Pediatric Primary Care Mental Health Specialist, Certified Breastfeeding Specialist/IBCLC Board Eligible, Holistic Care Advocate, and Supporter of Children and Their Families
I have so many thoughts on this topic, as both a parent and a pediatric primary care provider (PCP). My journey into the world of pediatric mental health was born out of necessity, but continues because of the huge rewards I see to children and their families when the right care is given. Simply put, there are nowhere near enough pediatric mental/behavioral health providers to meet the current demands. Most pediatric PCPs are trained extensively in child development, but are given very little training in the worlds of psychiatry and mental health disorders. Screening tools for anxiety, depression, substance abuse, and social determinants of health have improved identification of youth and families that are at risk, but as for the question of what to do next, many providers still feel inadequately prepared to give sufficient answers. See psychiatry? No one is taking new patients. No one takes our insurance. The wait for an appointment is 6-9 months. My spouse doesn't think my kid needs a shrink. See a therapist? I've called 3 offices and no one is calling us back. I don't know who to trust I did therapy in the past and it didn't help. We had a therapist we loved and she moved away. These responses either make us feel like there is no hope for our patients to get the care they need, or drive us to step up and find a way to offer that care. I, and a handful of my peers, sought to learn more, about the diagnostic criteria, the medication options, the behavioral health interventions that lead to successful outcomes for our patients and their families. We sought and continue to seek out educational opportunities, both formal and informal, on the diagnosis and treatment of the mental health disorders that affect today's youth. And we are seeing the difference. Our patients are seeing the difference. Daily I hear statements like the ones below: "We've seen so many people, and no one has ever done this for us before." "I know that you really care about how she is, and that makes such a difference to her and me." "How come no one ever gave us information like this before? This is so helpful." "We appreciate how you take the time to actually listen." "This medication has been a miracle for him. We feel like we have our child back." "We are seeing improvements and are so hopeful." We know primary care is an ideal setting for pediatric behavioral health. We are the ones who have known these children from birth, we are a place where families feel safe, we are people they already trust. More opportunities are needed to certify providers who are doing the work to become primary care mental health specialists, and insurance companies need to be pushed to prioritize aka pay for this care, for it is at the heart of lifelong health and wellness.
Three years ago, AAP, American Academy of Child and Adolescent Psychiatry (AACAP), and Children’s Hospital Association declared an emergency in youth mental health. While we have seen some policy progress, there is still so much work to do to best support the needs of young people. We call on all elected leaders to advance policies that prioritize the healthy mental and emotional development of young people.
