In a conference room at the University of Minnesota Masonic Children's Hospital, groups of pediatric residents are discussing the case of "Tara," a girl who needs help managing depression.
One of their fellow residents has just presented the case, and now these newly minted pediatricians have divided into groups — each with a doctor who has expertise in mental health in young people — to figure out what should be done.
The people who run the residency program at the hospital know that the numbers are lopsided and alarming: In Minnesota, more than a million people are under the age of 18, but there are only 140 child psychiatrists practicing in the state. And there's clearly a need. There's a 1 in 5 chance that kids will develop depression sometime between middle and high school and a 1 in 6 chance they'll develop serious anxiety.
Yet the people who take care of kids most of the time — like pediatricians and family doctors — don't get much training in how to treat mental health problems.
"In medical school, I think across the country there is a lack of that type of education," said Deirdre Croke, a second-year resident in internal medicine and pediatrics.
"We learn in the books about different disorders and medications and therapies," she said. "But practically speaking, I really only saw the pediatric component of behavioral health on a child psychiatry rotation in a juvenile detention facility."
That experience got Croke interested in pediatrics and behavioral health, but didn't do a lot to train her to deal with more common mental health issues like depression or anxiety.
She said events like this one will help her when she starts practicing on her own. It gives her the resources she needs, "either with forming therapeutic alliances, giving some therapeutic strategies, basic medication management if necessary. I definitely feel like this developmental rotation and some of these other core conferences is preparing us to do that."
Emily Borman-Shoap, who runs the pediatric residency program, said if a pediatrician refers a patient to a child psychiatrist, it can take months to get an appointment. It shouldn't be that way, she said, and it doesn't have to be.
"We know that the pediatrician, the family medicine provider, the nurse practitioner in primary care need to be ready to do some of the initial steps in helping a young person who's experiencing mental illness," Borman-Shoap said. "So, we're trying to figure out ways to better partner together so the pediatrician can work to the top of their skills and then hand it off if they need more help."
Every couple of weeks, Borman-Shoap brings the residents together to hear a case that deals with a mental health question and talk about it. It's just one of the things she and the residency team are doing to make sure these new pediatricians are comfortable with the subject.
"We'd like to get to a point where all pediatricians who graduate from our program and other programs can recognize and diagnose common behavioral health and mental health concerns and initiate the first next steps, whether that be recommending therapy or starting a medication," said Borman-Shoap.
Then, if those first steps don't work, the pediatrician can still refer to a psychiatrist. Joseph Hagan is a pediatrician in Vermont who's been a national leader in pushing for pediatricians to deal more with behavioral health, which he said he's seeing more and more.
"Mental health is health," he said. "It's all together and I think that's been a real change during my career and I'm very pleased to see that."
Have you had to wait to get your child in to see a psychiatrist? We want to hear about your experience. Email MPR News reporter Alisa Roth.
This reporting is part of Call to Mind, the MPR initiative to foster new conversations about mental health.
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