Decision support service offers assistance in diagnosing paediatric mental health issues

It is estimated that one out of five children in the United States is suffering from a treatable mental condition. However, with only eight child and adolescent psychiatrics for every 100,000 children in the country, there is growing concern that kids suffering from mental health conditions are not receiving the good care they deserve. To address this problem, doctors at Nationwide Children's Hospital are partnering with paediatricians and family doctors to make sure kids suffering from anxiety, depression and other mental disorders are receiving the care they need - and quickly.

According to a survey conducted by Nationwide Children's Hospital, 85 percent of primary care doctors are uncomfortable diagnosing and treating anxiety in children, with another 54 percent uncomfortable diagnosing depression. Primary care doctors are typically the first to recognise potential mental problems in their patients but since they treat a wide range of conditions, both physical and mental, the opinion of a paediatric psychiatrist can prove invaluable when it comes to diagnosing and treating mental conditions. In addition, researchers and care providers alike agree that much of this discomfort stems from recent controversies surrounding prescribing antidepressant medications that display black box warnings about potential side effects for their use in children.

To help empower paediatricians and family doctors, paediatric psychiatrists and mental health specialists at Nationwide Children's have developed a program called the Telephone Decision Support Service which provides primary care doctors with a second opinion for diagnosing and managing mental health problems in children.

When presented with a patient whom general practice doctors feel may be suffering from a mental condition and could benefit from prescription medications, the doctor can contact an on-call psychiatrist or advanced practice nurse at Nationwide Children's to discuss the case. After hearing the doctor's findings and opinion, the decision support professionals offer insight as to course of treatment.

'We want to identify those kids who are most severely ill first and provide them the level of care that they need. If they need to be seen in a speciality care setting, we want to get them there right away,' said John Campo, MD, medical director of Behavioural Health Services and chief of Child and Adolescent Psychiatry at Nationwide Children's Hospital and a driving force behind the Telephone Decision Support Service.

By using this program, primary care doctors are able to serve as the first line of defence to treat kids with common mental conditions like general anxiety and depression. By taking care of this group of patients, more appointments become free with mental health providers at Nationwide Children's for those patients needing more specialised mental health care. This stepped-collaborative care approach quickens the treatment for both groups of patients while ensuring those who need immediate psychiatric treatment get appointments sooner and those with general conditions don't suffer any longer.

'Not only might it improve quality of care that can be delivered and improve access to care, but it has the potential actually to either postpone or prevent speciality visits,' said Dr Campo, also a professor of Clinical Psychiatry and Pediatrics at The Ohio State University College of Medicine.

In the near future, doctors at Nationwide Children's hope to incorporate telemedicine and video conferencing to the Telephone Decision Support Service to better assist doctors in rural areas and those families without readily available access to specialised mental health care.