I have 15 minutes to treat your child’s anxiety

As you scan the overcrowded waiting room, you wonder how many other parents are anxiously tapping their toes against the linoleum hoping to end their visit with more answers than questions. You ease back in the cushioned chair, rubbing elbows with the person next to you, trying to focus on the task at hand. The clipboard on your lap has an attached screening form with questions about anxiety, but the wording appears somewhat of an exercise in simply checking off boxes. How can a list of questions, without any option to elaborate, present an accurate representation of the unique being that is your child? Soon, your train of thought begins to derail and you ask yourself, “Isn’t the doctor going to ask my son all of these questions?” “Are we going to try to do a deeper dive into why he feels this way?” “Is this appointment just going to end with a prescription thrown at me to make room for the next patient?” 

Maybe as a parent you have been in this situation. If not, then you likely know someone who has. As outpatient wait lists of psychiatric and mental health specialists stretch into months, parents are now turning to their child’s primary care provider for help in addressing mental or behavioral issues. Between the years of 2005-2019 alone, a study revealed pediatric offices saw an uptick of 44.7% in visits regarding mental health concerns. As the lockdowns and chaos of the pandemic has faded into memory, the hope was to see a boost in children’s mental health and the need for these appointments drop. But sadly, the opposite has happened. Pediatric providers are continuing to deal with an ever- worsening problem that the healthcare system cannot seem to curb as an estimated 13%-20% of children are reported to be suffering from a mental or emotional behavioral disorder. Despite this growing need, pediatric mental health providers are few and far between. The American Academy of Pediatrics reports that currently there are only 10 mental health providers to every 100,000 children while the need is estimated to be 47 providers to every 100,000 children. And the inpatient world is no better. Rural hospital doors across the nation are being shut for good and psychiatric and mental health wings of the hospital alternate between being dangerously understaffed or temporarily closed.

Even six years post-COVID, medical institutions are still playing catch up with general health care visits. Memos highlighting shorter appointment times requirements and reimbursement bonuses for seeing upwards of 15-20 patients a day has become the new norm in order to have people seen and meet financial expectations of outpatient practices. But this only adds to the challenges in the world of mental health care. Parents are waiting weeks, even months to have their child see even their regular provider and begging to be placed on a cancellation list to obtain a sooner appointment. With upper management expectations of shorter visits, higher patient volume, and families turning to their child’s primary for mental health care, how can the system adequately respond to this crisis?

Unless a patient is already slated for a thirty minute wellness check, the slot provided for an acute concern is, on average, fifteen minutes. This does not account for checking in at the front desk, being assessed by the nurse, and then the wait time before your provider has even laid eyes on your child. By the time the doctor even walks through the door, parents feel so rushed, the list of questions saved in their phones gets pushed to the wayside or limited to one or two priority questions as their child gets examined. To be frank, it is nothing short of impossible to provide quality care and perform a detailed evaluation in the time allotted for a critical concern when it comes to your child’s mental health.

Policy makers continue to push for protocols to make a dent in this rising curve. Proposals include methods to catch mental health issues early, such as beginning to screen for anxiety and depression as early as seven and eight years old, but this equates to a band-aid on a gaping wound. Documented screening tools are being used to bypass taking the time to assess patients beyond the piece of paper. Families are then offered a prescription or handed a list of additional resources in their area as they head out of the room. This rotating door effect is frustrating many families and leaving them at a loss of what to do next.

In order to start seeing a shift in the number and severity of mental health concerns in children, policies created need to recognize the obvious gaps in care that continue to widen in the pediatric setting. Requiring an assembly line of patients in and out of the office with limited appointment times, plus dwindling resources is doing nothing to correct the kind of care needed for our kids. While recommended measures suggested above may result in larger bonuses or a glamorous bottom line, they are putting the most vulnerable patients at higher risk for falling through the cracks.

Proposed reform and policies surrounding pediatric mental health care should not come from upper management and politicians alone. Pediatric health care workers including nurse practitioners, doctors, and nurses need to be involved on the ground floor when it comes to legislation. Screenings are only useful tools if the visit consists of a careful examination, a complete medical and family history, scheduled follow up visits, and a family-centered plan of care. Appointments should be tailored to fit patient and family needs including length of time and frequency. Collaborative meetings should be in place if there are multiple providers involved in caring for the child so that everyone, including the family, is on the same page with the same set goals. In other words, a concierge medicine approach that focuses on family-centered and individualized care will help to address the mental health crisis an in an efficient manner.

Without utilizing front-line workers, suggested changes such as earlier screening protocols will never focus on the certain aspects of care necessary to see advancement in the world of pediatric mental health. If we continue to only treat this as a numbers game without understanding how an appointment will be worth a patient’s time, then we will never see children receive the type of care needed to make a positive impact on their childhood and their lives as a whole.