The US is facing a crisis in youth mental health, with demand for services outpacing supply. The Massachusetts Child Psychiatry Access Program (McPAP) and its peers across the US that are part of the National Networks for Child Psychiatry Access Programs (NNCPAP) help to build a referral network for primary care providers seeking psychiatry consults. The programs have proved economical, and McPAP alone enrolls around 1.5 million children and costs $3.4m annually. However, access to therapy remains a challenge for such programs.
The United States is facing a youth mental health crisis that is getting out of hand. With demand for mental healthcare access outpacing supply, healthcare providers are struggling to meet pediatric patient needs. The shortage of providers, especially psychiatrists, the issue of social stigma, and patient navigation hurdles are some of the factors that have contributed to the problem of inadequate mental healthcare access.
The Massachusetts Child Psychiatry Access Program (McPAP) was established nearly two decades ago to address the supply and demand problem in mental healthcare access. Although it does not solve all the challenges in youth mental and behavioral health access, it presents an effective model for tackling patient care access challenges. Together with its peers across the country that are part of the National Networks for Child Psychiatry Access Programs (NNCPAP), McPAP builds a referral network for primary care providers seeking a psychiatry consult.
In 2021, 37% of high schoolers said their mental health deteriorated during the COVID-19 pandemic, and 44% said they had felt persistently sad or hopeless, according to figures from the Centers for Disease Control and Prevention (CDC). Separate CDC data showed that the US is in crisis mode, with the proportion of pediatric emergency department visits for mental health conditions increasing in 2020. Pediatric mental health visits in the ED are becoming such a problem for overcrowding that some states, like Massachusetts, are diverting patients to other healthcare resources rather than the ED.
The problem is that the upstream resources needed to prevent an ED visit aren’t there. Kids need mental health intervention before they end up in the ED, but according to Dr. John Straus, founding director of McPAP and president of NNCPAP, those interventions aren’t always able to happen. There is a shortage of child behavioral health providers, particularly psychiatrists, and access to them is tough. The Association of American Medical Colleges confirms this, saying the nation will have a shortfall of between 14,280 and 31,109 psychiatrists within a few years.
However, pediatric healthcare access is doing comparatively well in the primary care space, where around half of kids have a medical home, which far outpaces pediatric healthcare access in other specialties, according to the Kaiser Family Foundation. McPAP and NNCPAP capitalize on that pediatric primary care access and operate on the principle that kids should be able to get mental healthcare access within the primary care setting.
When pediatricians meet with patients they believe need a mental or behavioral health intervention, they can call a psychiatrist within the McPAP network for a consultation. This process, which was manual during McPAP’s early days but has since embraced telehealth models, usually took around 30 minutes, a far quicker process than getting a kid in for an in-person visit with a psychiatrist using a traditional model. The McPAP model works well because it leverages a pediatrician’s prescribing power. After the consult with the psychiatrist, the pediatrician can prescribe any necessary medication and help with medication management and adherence plans.
McPAP quickly grew into NNCPAP, and by 2015, there were around 20 programs across the country. The programs got their funding through state legislatures and grant funding, and soon proved very economical. According to Dr. Straus, the Massachusetts program enrolls around 1.5 million kids and costs $3.4 million each year, which shakes out to around $2.30 per kid per year.
Around 2015, NNCPAP started getting attention at the federal level, with Massachusetts Representative Katherine Clark bringing the program to the House floor to create federal funding. That funding came as part of the 21st Century Cures Act, and since then, the bipartisan Safe Communities Act has also created some funding mechanisms. The Health Resources and Services Administration
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