Making Teen Mental Health a Priority: Doctors Changing Lives

David Keller, M.D.
Clinical Associate Professor, Pediatrics & Senior Analyst, Center for Health Policy and Research, University of Massachusetts Medical School

The gap between primary care providers and child and adolescent mental health specialists can be daunting. But, an innovative project in Massachusetts is fostering successful collaboration, and improving patient mental health care. A pediatrician discusses how the program has changed his practice.

A 17-year-old seemed clinically depressed and a 13-year-old boy arrived newly discharged from a psychiatric facility with a bag full of medications and the need for a referral to a specialist. Dr. David Keller wanted to help, but wasn’t sure how. He related his experience before a Capitol Hill audience of policymakers and mental health influencers at TeenScreen National Center’s 2011 Trendell Health Policy Forum.

A Massachusetts pediatrician, Dr. Keller recalled that he was unsure about mental disorders and had no professional connection to child and adolescent mental health specialists for consultation. As he continued to see more patients with mental health and behavioral issues, he knew the problem wasn’t going away. He also knew that he wasn’t alone. Adolescents experience high rates of depression, anxiety disorders and other mental health problems, and there are not – and never will be – enough child and adolescent psychiatrists to meet their needs.

“We can’t train enough child psychiatrists to meet the need,” said Dr. Keller, who is also a Clinical Associate Professor of Pediatrics and Senior Analyst at the Center for Health Policy and Research at the University of Massachusetts Medical School. “Pediatricians are frequently called on to close the gap. We see the patients, but we don’t feel like we’re trained. Child psychiatrists do have the training but they are rare and hard to access.”

In 2005, a group of primary care physicians and behavioral health specialists in Massachusetts broke through the conundrum by creating MCPAP – the Massachusetts Child Psychiatry Access Project. Now available or being developed in 26 states, the approach is providing primary care providers with the support they need to treat common mental health concerns with confidence.

Connecting Primary Care to Specialists

MCPAP focuses on building a partnership between primary care providers and child psychiatric specialists. As the two disciplines have historically had little collaboration, primary care providers first learn how to work with a behavioral health team.

“Our styles of work are different,” said Dr. Keller of mental health specialists and primary care. “We don’t know each other, and there is a trust factor.”

The MCPAP teams, based at one of six academic medical call centers throughout the state, are available to primary care providers around the clock. Typically, a phone consultation is sufficient. A child psychiatrist may occasionally request to see a patient in person for more complex cases.

For Dr. Keller, the consultations have helped guide his decisions on the newly discharged psychiatric patient, the clinically depressed 17-year-old and countless others. The project has also increased his level of comfort managing the mental health issues of his young patients, as it has for many of his colleagues. After five years, MCPAP, which now serves more than 6,000 youth annually, has bridged the primary care confidence gap. More than 63% of all primary care providers in Massachusetts say they are confident in managing adolescent mental health programs, compared with 8% in 2005.

“Primary care doctors have been helped with this collaboration,” he said. “It’s a practice transformation.”