Historically, physical and
The REACH Institute is a nonprofit organization that trains pediatric primary care physicians on mental health diagnoses and treatment. REACH has successfully trained 6,000 providers since its founding in 2006 and is set on growing its numbers. Given the Biden administration's recent inclusion of the Restoring Hope for Mental Health and Wellbeing Act, which is also working to provide mental health cross-training for primary care doctors, REACH is not alone in recognizing how damaging this knowledge gap is for families.
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"The issue is that kids who need mental health services are not getting them," says Dr. Lisa Hunter Romanelli, CEO of REACH. "Despite primary physicians often being first responders to various [concerns], the typical pediatric primary care provider does not get a lot of training in medical school on mental health issues in children."
This means providers will refer patients to an appropriate specialist, but only if they can identify the mental health problem to begin with. However, referrals are not always ideal, since there are usually long wait times to see children's mental health professionals, explains Dr. Romanelli.
That's not surprising, given that out of the 100,000 U.S. clinical psychologists in the U.S., only 4,000 serve children and adolescent patients, according to the American Psychological Association. Notably, the CDC estimates one in five children has a mental disorder, but only 20% actually receive mental health care.
Dr. Noor Jihan Abdul-Haqq, a general pediatrician based in Oklahoma City, knew there was a gap in her education and she says she struggled to fully address her patients' needs. After hearing about REACH through a Facebook group, she signed up for a course in 2018 and hasn't looked back.
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"I was seeing a lot of patients with possible ADHD, depression and anxiety, but I didn't know how to approach it," says Dr. Abdul-Haqq. "If a child comes in with abdominal pain and it turns out to be anxiety, then we have to refer them out. While their family waits for two months for an appointment, what happens to my patient?"
Dr. Abdul-Haqq is now part of REACH's faculty, training fellow physicians on how to identify children with mental health challenges and what help they can offer within their scope of practice. The course starts with a three-day interactive workshop, followed by bi-weekly meetings for six months. Each session is led by either a pediatrician or nurse practitioner and a child psychiatrist, where they discuss case studies and evidence-based treatments for mental health challenges, namely ADHD, depression and anxiety.
Physicians are trained on what information they should share with parents regarding their child's condition, what medication to prescribe and when it is necessary to do so and when to refer the child to a social worker or psychologist. For Dr. Abdul-Haqq, this is necessary if not life-saving knowledge.
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"I do about five or six mental health visits a day," she says. "It's inevitable — to be a good clinician, you have to realize that mental health is just as important as physical health."
Dr. Abdul-Haqq recalls two children who walked into her office recently and marked having suicidal ideations on their PHQ-9s, a patient questionnaire that assesses one's depression severity. As a primary care physician, Dr. Abdul-Haqq was able to discuss options like therapy groups and medications with the children's parents.
"The parents had no idea," she says. "But now we can get them some help and those kids had a sigh of relief."
And if the child is suffering, the
"Caregivers with children who have unmet mental health needs are under a lot of stress and pressure," says Dr. Romanelli. "The more children's needs are met, the better caregivers can focus on their jobs."
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Employers can provide holistic care solutions by prioritizing integrated health services in their benefits decisions and creating provider networks with cross-trained primary care physicians, explains Dr. Romanelli. Not to mention, employers and employees alike will save money the faster providers can pinpoint the root of their
"Our minds and bodies are connected," says Dr. Romanelli. "For example, children with anxiety often have a lot of physical complaints like stomach aches and headaches. But if you spend all your time on the physical complaints and ordering tests, you will not treat the underlying cause."
Both Dr. Romanelli and Dr. Abdul-Haqq are confident that primary care and mental health care will become increasingly combined disciplines, especially given just how expensive and difficult it can be to see a specialist. Dr. Abdul-Haqq encourages other primary care providers to close the gap in their mental health knowledge.
"As a pediatrician, I'm treating the whole child," she says. "It's very rewarding for me to see how I can literally change the course of my patients' lives."
