Morning Zen Guest Blog Post ~ COL (Ret) George Patrin, M.D.
The article on integrating care for mental health and substance use problems within primary medical care for children and adolescents, highlighted by SPRC, from the UCLA Newsroom – Health and Behavior Section (Meg Sullivan | August 10, 2015) - "Kids, teens win when mental health providers team with pediatricians, family doctors, UCLA study finds" - is touted as the "First meta-analysis of integrated care for youth (validating) the increasingly popular approach."
The author writes "for the past decade, cutting-edge health care providers and researchers have increasingly pushed to integrate care for mental health and substance use problems within primary medical care for children and adolescents." This statement is true. In fact, insightful practitioners are well aware children have been unable to gain audience with behavioral health colleagues and have been attempting integration since 2000. I know - we were making these attempts during my time in the USArmy. "Their 'hope' is children and teens (suffering) from mental and behavioral disorders (will) fare better if pediatricians (and) family doctors took an active role in linking them with mental health care." This comment smacks of the insinuation that primary care givers haven't been trying to be involved and get such services for their kids. This is usually a perception put forth by the very behavioral health care specialists making themselves unavailable for consult under a guise of being overwhelmed and swamped. With this article, we are supposed to be surprised that "a team of UCLA researchers has studied a wide range of published research on the approach and found that children and adolescents who receive integrated mental health and medical treatment are 66 percent more likely to have a good outcome than those who receive more traditional primary care." I'm sorry, but we needed a meta-analysis study to tell us this?
This 'news' was published by the UCLA in the current issue of JAMA Pediatrics. We have been trying to tear down these silos and get same-day evaluation and treatment for children, rather than send them to the Emergency Room for a crisis evaluation and temporary hold, for 20 years! I weary of continued funds put forth by leading organizations, in this case, the National Institute of Mental Health and the American Psychological Association’s Society for Clinical Child and Adolescent Psychology (31 studies comparing outcomes in an integrated model covering outcomes for 13,129 children and adolescents) and reported on by SPRC, instead of stating what we already know: access works, increasing the likelihood of a positive outcome by putting those funds to work helping practices transform their processes to same day, integrated care. "The take-home message is that integrated care works,” said lead author Joan Asarnow." Duh. True, "we have a huge mental health problem in this country.”
The authors point out “(in primary care) mental health was often not addressed, or if it was, patients were referred to a mental health specialist, and the child’s health insurance determined whether or not the child had access to the mental health specialist as well as the quality of that care.” A study on why insurance companies are violating the 2008 Parity Law withholding care would be a better use of these research dollars. Hopefully, times ARE changing, but only if we stop allowing mental health coverage by insurance providers to be inadequate. Remove hurdles primary care doctors have faced in joining forces with psychologists, psychiatrists, and social workers by changing our entire appointment and referral processes and take the insurance companies totally out of these decisions. Period.
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COL (Ret) George Patrin, M.D., spent over 23 years as an Army Pediatrician and Healthcare Administrator concentrating on Family Advocacy and Healthcare Process Improvement. His final assignment was as Northern Regional Command Special Projects Officer for Patient-Family Centered Healthcare assisting in writing DoD Patient Centered Medical Home (PCMH) Guidelines and Training. He has been a staunch advocate for both soldier and family member readiness and timely access to health care throughout his military career. He is a sought after speaker on parenting education, child abuse prevention, school learning and behavior problems, and healthcare administration optimization. Dr. Patrin is a member of the Children's Mental Health Network Advisory Council. He can be contacted at firstname.lastname@example.org.