Mental Health Access in Primary Care Pediatrics: an Age-Old Perennial Challenge and a Contemporary Solution
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Abstract
Background:
In the US, mental health conditions affect 20% of children and adolescents; yet, because of significant mental health provider shortages and stigma surrounding these conditions, only a small fraction of this 20% receives appropriate and timely care. In this age group, untreated mental health conditions tend to get worse with time, and they significantly contribute to disability and mortality, with the top leading causes of death in children and adolescents being accidents, homicide, and suicide. Additionally, untreated mental health conditions contribute to no less than one third of excess cost and waste in the US healthcare system. While primary care physicians may be optimally positioned to insure early detection and care for mental health conditions, in reality they may be either unprepared or pressured for time in their practice. The authors hypothesize that universally available internet and smart phone-based technologies may improve the efficiency and effectiveness of primary-care based mental health screening and may be powerful tools to address barriers to care and to improve overall patient well-being and self-efficacy.
Methods:
We formed a collaboration between two combined pediatric/child and adolescent psychiatric physicians who actively practice both specialties, one executive leader in mobile app development for healthcare, and one psychiatry practice administrator/social worker. The group has actively worked on an app- and internet-based system that includes efficient and patient-friendly primary care-based screening, additional touch points between providers and patients, patient education and self-help resources, and collaboration and mutual consultation between primary care physicians and child and adolescent psychiatrists.
Results:
Using fictitious but realistic vignettes, we will illustrate the practical application of the mobile app-based technology and highlight where it may help to address gaps in the usual system of care that could otherwise lead to delayed, minimal, or no care and ultimately to adverse outcomes and waste. We will also illustrate how this system complements telepsychiatry as a mechanism to expand capacity and create a sustainable collaboration between primary care and child and adolescent psychiatry.
Discussion:
Mobile app technology, especially in combination with telepsychiatry, may be a powerful tool to address mental healthcare shortages in the US and - with appropriate adaptations, and with the assumption that smart phones are widely available - in other developed and developing nations of the world.
In the US, mental health conditions affect 20% of children and adolescents; yet, because of significant mental health provider shortages and stigma surrounding these conditions, only a small fraction of this 20% receives appropriate and timely care. In this age group, untreated mental health conditions tend to get worse with time, and they significantly contribute to disability and mortality, with the top leading causes of death in children and adolescents being accidents, homicide, and suicide. Additionally, untreated mental health conditions contribute to no less than one third of excess cost and waste in the US healthcare system. While primary care physicians may be optimally positioned to insure early detection and care for mental health conditions, in reality they may be either unprepared or pressured for time in their practice. The authors hypothesize that universally available internet and smart phone-based technologies may improve the efficiency and effectiveness of primary-care based mental health screening and may be powerful tools to address barriers to care and to improve overall patient well-being and self-efficacy.
Methods:
We formed a collaboration between two combined pediatric/child and adolescent psychiatric physicians who actively practice both specialties, one executive leader in mobile app development for healthcare, and one psychiatry practice administrator/social worker. The group has actively worked on an app- and internet-based system that includes efficient and patient-friendly primary care-based screening, additional touch points between providers and patients, patient education and self-help resources, and collaboration and mutual consultation between primary care physicians and child and adolescent psychiatrists.
Results:
Using fictitious but realistic vignettes, we will illustrate the practical application of the mobile app-based technology and highlight where it may help to address gaps in the usual system of care that could otherwise lead to delayed, minimal, or no care and ultimately to adverse outcomes and waste. We will also illustrate how this system complements telepsychiatry as a mechanism to expand capacity and create a sustainable collaboration between primary care and child and adolescent psychiatry.
Discussion:
Mobile app technology, especially in combination with telepsychiatry, may be a powerful tool to address mental healthcare shortages in the US and - with appropriate adaptations, and with the assumption that smart phones are widely available - in other developed and developing nations of the world.
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