Between one-quarter to as many as one-half of all visits to pediatric primary care providers now involve behavioral, emotional, or developmental concerns, and the demand for mental health services is growing. From 1990 to 2003, the general medical sector saw the rate of treatment for mental illness rapidly increase by more than 150 percent (Kessler et al., 2005). This is partly a result of the growing recognition of the importance of mental health to overall health, but also due to the prevalence of mental health disorders and the shortage of mental health professionals specializing in the care of children and adolescents. For more, see our fact sheet.
 

TeenScreen National Center’s Federal Policy Recommendations

To successfully integrate mental health into primary care settings, many primary care providers have indicated a need for:

• clinical consultation and referral support
• additional training
• payment reform

Expanding Clinical Consultation and Referral Support

While primary care providers can and often do provide care for youth with mental disorders, there continues to be an urgent need for clinical consultation with and referral to specialty mental health providers. Unfortunately, many providers encounter significant difficulty in arranging specialty mental health care for their patients.

One innovative method of overcoming this shortage is to enhance primary care providers’ ability to treat mental health disorders. A number of states are employing or developing new resources to provide free clinical consultation in child psychiatry to primary care providers, as well as referral services. For more information, visit the National Network of Child Psychiatry Access Programs.

Another promising avenue to expand access to specialty mental health services for youth is the use of telemedicine, which can connect patients in underserved areas with psychiatrists and other healthcare professionals through videoconferencing. Read more.

States and the federal government should support the development and expansion of these programs through increased funding for grants and pilot demonstrations.
 

Additional Training in Mental Health Care

A significant proportion of primary care providers report that they are hesitant to offer mental health screening due to a shortfall in their mental health training. In a 2007 survey, more than 60 percent of pediatricians indicated that they lacked confidence in their training and ability to address mental health disorders in children and adolescents.

To address this gap, the Health Services and Resources Administration (HRSA) and other agencies in the Department of Health and Human Services should direct funding for primary care workforce training to enhance training for future medical graduates and offer additional training in mental health to primary care physicians already in practice. Read more.
 

Payment Reform

In many cases, primary care providers are prohibited from billing for “mental health codes” that would allow them to claim reimbursement for screening for, evaluating, diagnosing and providing counseling and guidance for mental health disorders. In addition, primary care providers are often not reimbursed for consultation and care coordination for patients who have been referred to specialty mental health services.

Payment policies – whether fee-for-service, capitated, bundled, or otherwise calculated – should ensure that primary care providers are appropriately compensated for offering prevention and treatment services for mental and behavioral health disorders.
 
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