The United States is experiencing a youth mental health crisis, with a shortage of mental healthcare access. John Straus, the founding director of the Massachusetts Child Psychiatry Access Program, has built a referral network for primary care providers to seek psychiatry consultations to address the issue. The program has become an effective model to tackle patient care access challenges. The National Networks for Child Psychiatry Access Programs fill in the gaps by building a referral network for primary care providers seeking a psychiatry consult.
The youth mental health crisis is escalating, and the demand for mental healthcare access is far outpacing the supply. The lack of access to behavioral and mental healthcare has left much to be desired, with the issues of social stigma, provider shortages, and patient navigation hiccups getting in the way. John Straus, MD, the founding director of the Massachusetts Child Psychiatry Access Program (McPAP) and the president of the National Networks for Child Psychiatry Access Programs (NNCPAP), has spent nearly two decades addressing this problem. McPAP, which was launched in 2004, builds a referral network for primary care providers seeking psychiatric consultations. It has become an effective model for at least chipping away at patient care access challenges. This article discusses the youth mental health crisis in the United States, the role of primary care as a mental health access site, and how the referral network at NNCPAP and McPAP is equipping healthcare organizations for the next phase of healthcare delivery that prioritizes team-based care and integration of behavioral health and primary care.
Snapshot of Today’s Youth Mental Health Crisis According to the Centers for Disease Control and Prevention (CDC), in 2021, more than a third (37 percent) of high school students reported that their mental health had deteriorated during the COVID-19 pandemic, and 44 percent said they had felt persistently sad or hopeless. Pediatric emergency department visits for mental health conditions increased in 2020, according to a February 2022 Morbidity and Mortality Weekly Report, indicating that the United States is in crisis mode. The problem is that the upstream resources needed to prevent an ED visit are not available. Children need mental health intervention before they end up in the ED, but according to Straus, those interventions are not always able to happen.
Pinpointing Primary Care as a Mental Health Access Site The early interventions that ideally prevent mental health emergencies are hard to come by because the clinicians who helm them (psychiatrists) are hard to come by. There are a limited number of child behavioral health providers, particularly psychiatrists, and access to them is tough. Data from the Association of American Medical Colleges (AAMC) confirms this. In 2022, the AAMC said the nation will face a shortage of between 14,280 and 31,109 psychiatrists within a few years.
But where pediatric healthcare access is doing comparatively well is in the primary care space. The Kaiser Family Foundation says that, as of 2021, around half of the kids have a medical home, which far outpaces pediatric healthcare access in other specialties. McPAP and NNCPAP capitalize on pediatric primary care access and operate on the principle that kids should be able to get mental healthcare access within the primary care setting.
The McPAP and NNCPAP Referral Network 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 takes around 30 minutes, making it 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.
NNCPAP has proved very economical. According to Straus, the Massachusetts program enrolls around 1.5 million kids and costs $3.4 million each year. That shakes out to around $2.30 per kid per year. Around 2015, NNCPAP started getting attention at the federal level, with Massachusetts.
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