Imagine that your 12-year-old daughter cuts her arm superficially with a pair of scissors because she is having emotional turmoil that she doesn’t know how to handle. The school counselor calls you and says that your child showed the marks on her arm to her best friend in class, and the concerned friend notified the counselor’s office. The counselor tells you that you need to have your daughter assessed by a physician who specializes in mental health, and that she cannot come back to school without a letter from a doctor indicating that she is safe to be on campus. She says that as the counselors learn more about the importance of mental health issues in middle school kids, they have strict rules about ensuring kids get the help they need.
How long would you expect to wait for a child psychiatry appointment in these circumstances?
In many communities, unless your child needs to be in the hospital, you might not be able to get in to see a doctor for months.
You sit down and try to talk to your daughter, and quickly realize that you are in over your head. She sobs uncontrollably, and says she has been feeling terrible for weeks. She had seemed like her usual self, and you are stunned that this all happened right under your nose. Now you’re both overwhelmed, and you still don’t know how to get help.
You pull out the phone book, and start calling psychiatry clinics. Most of the offices don’t see children, and the few that do see children don’t take your insurance. Even if you pay cash, the first appointment you can secure is two months from now.
Your child can’t stay out of school for two months, and you don’t feel confident that you’re able to help her with her emotions right now. While your appreciate the school’s attention to your child’s safety, you don’t know how to do what the counselor asked you to do.
You call your pediatrician’s office, explain what happened, and ask if they can evaluate her. The nurse tells you that their clinic isn’t qualified to evaluate this issue, and further, they don’t know where you can go. The nurse says it has become impossible to find mental health help, and she thinks you might have to take your daughter to a hospital, where she would have to stay for up to a week.
This scenario is common. It’s getting harder and harder to access mental healthcare services. This is true for adult patients as well as children and adolescents. Psychiatrists are aging out of the field, and too few young physicians are choosing this necessary specialty. Awareness is growing, and more and more people are asking for help. But then patients are finding that there is nowhere to get the help they need.
Primary care clinics are overwhelmed with the mental healthcare needs of their patients, and often do not feel qualified to handle the complex mental health needs of their patients.
In order to meet the needs for mental health care, things are going to have to change. What can be done?
Researching and educating families, communities, and schools about how to develop emotional skills, and open dialogues can decrease the risk of mental health crisis.
Primary care and specialist collaboration can increase available care.
3. New Models of Care
Co-location by a mental health professional with primary care, and regular on site consultation have been shown to improve access to mental health care services. Integrating mental health into primary care is helping meet the need for care.
What other ideas do you have?