You’re at a wellness check-up for your son, Tommy, and much of the visit has been spent catching up with the doctor about your trip to Yosemite, Tommy’s recent soccer tournament, and the fact that he’s getting pimples. Tommy mentions that since the start of seventh grade this year, he’s had frequent headaches and difficulty sleeping. You have noticed a mood change lately, but his father chalks it up to puberty. You glance at your watch and realize you have to get back to work, and Tommy still has to get his vaccinations. You remain silent about your deeper concerns.
“The mind and the body are like parallel universes. Anything that happens in the mental universe must leave tracks in the physical one.” Philosopher Deepak Chopra’s quote refers to the undeniable relationship between one’s mental state and physical well-being. This mind-body connection explains how a basketball player can snap out of a cold shooting streak after just seeing a free throw go through the basket, or why a husband craves pickles and has morning sickness when his wife is expecting a baby. Physical symptoms due to anxiety and depression in a child can range from a recurring tummy ache before school to a debilitating loss of energy that prevents a child from getting out of bed.
Back to Tommy’s visit…
Fortunately, while you were waiting to be seen, the pediatrician had Tommy complete a quick screening questionnaire for depression. The American Academy of Pediatrics has recently recommended such screenings at wellness checks for children and adolescents older than twelve.
Tommy’s score triggered more in-depth questioning by your pediatrician, who concludes that he has mild depression and refers him to a child psychologist for counseling. The diagnosis confirms your fears, but you are relieved that this has been caught early.
A few weeks pass before Tommy is able to get in with a popular counselor or psychologist in your area. Therapy seems to be going okay, but he’s lost a few pounds, and his performance at school is sliding. He quits the soccer team to reduce stress, but this seems to only make him feel more isolated. He is occasionally tearful and going to school is increasingly difficult.
Feeling some desperation, you go back to see your pediatrician, who hesitantly mentions the possibility of starting Tommy on an antidepressant. Sensing reluctance from the doctor and knowing Tommy’s father is philosophically opposed to medication, you accept a referral to a child psychiatrist for more specialized management. Stating that these appointments are hard to come by, the pediatrician gives you some names. You call as soon as you get home. The first psychiatrist is out of network. The second participates with your insurance, but doesn’t have an appointment available for three months. Suddenly, you’re feeling overwhelmed.
Unfortunately, Tommy’s scenario is not uncommon.
In 2015, nearly 71 percent of children in Virginia who have had major depressive episodes (55,000 children in all) did not receive mental health services. How can the system be improved?
Early recognition is the first hurdle. This encompasses eliminating stigma and educating parents, teachers, and healthcare providers about the warning signs of common mental health disorders. The next step is getting the child the help he needs. According to the Centers for Disease Control (CDC), one in three pediatricians reports they have insufficient training to diagnose and treat children with mental disorders.
As in Tommy’s case, there can be great difficulty accessing the system due to factors such as high costs stemming from inadequate insurance coverage, limited availability of providers (counselors, behavior therapists, psychologists, and psychiatrists), stigma about mental wellness, and social barriers, as well as other factors related to getting care, like transportation to appointments.
So what is integrated behavioral healthcare?
Imagine if Tommy’s pediatrician could simply walk with Tommy and his mom down the hallway for a warm hand-off to the practice’s own psychologist. Because of collaboration with his colleague who has developed a plan and is well-connected with local child psychiatrists, Tommy’s regular doctor is in a better position to help Tommy.
Also known as integrated behavioral healthcare, this model blends medical and behavioral health care within one medical home, realizing that they are one in the same. Not only is this light years more efficient, but Tommy can be treated in a place where he gets high fives from the nurses and doctors and he and his caregivers feel safe and comfortable.
What if Tommy eventually still needs to see a psychiatrist? Another walk down the hall and live video conferencing – known as telepsychiatry – means Tommy and his parents can use a big screen TV to meet remotely with a local provider.
There is little doubt that the prevalence of behavioral health disorders is on the rise. In fact, it is estimated that one in five children in the United States will be diagnosed at some point with a behavioral health-related disorder. It is no less important to screen for these problems at routine health assessments than it is to check blood pressure or listen to a child’s lungs. With early recognition of symptoms and use of an integrated system to efficiently provide treatment, children like Tommy will be more likely to receive the care they need. The effect on a child’s life is immeasurable because there is truly no health without mental health.
Many initiatives, such as the Virginia Mental Health Access Program (VMAP), are striving to educate providers, integrate services, and improve access to mental healthcare for the children and adolescents of Virginia. You can learn more about this initiative at virginiapediatrics.org.