talk therapy often helps

Although my training was in Internal Medicine (IM) with a subspecialty in Nephrology (nephros is Greek for kidney), I've had a long-standing interest in Mental Health (MH) issues. My medical school (University of Wisconsin circa 1962-1966) included four years of MH classes. Then I supervised, in various Air Force roles, mental health departments and later commanded a hospital with 90 MH beds (versus 15 each of IM, Peds, Ob-Gyn & Surgery). But there's an even more important reason for me to care about the field...my wife is a clinical social worker, i.e., one who sees patients (they now call them "clients," but I don't) with MH problems.

Since I'm married to a MH therapist, I'm familiar with the Diagnostic and Statistical Manual for Mental Disorders, DSM for short. It'a a publication of the APA, the American Psychiatric Association and is the "lingua franca," the standard terminology for all working in the MH field. That includes psychiatrists, who are, of course, MDs and therefore can prescribe medications (I often get the impression that's all many of them do these days), psychologists (PhDs who, in general, can't, although two states, New Mexico and Louisiana, have enabled some who obtain a master's degree in clinical psychopharmacology to write RXs for MH meds only), clinical social workers (who have a Masters degree or, occasionally, a PhD, but can't prescribe pills), and a variety of other therapists (e.g., marriage and family therapists), most of whom have a Masters degree and can't prescribe meds.

Of course those of us who have MD degrees and aren't MH specialists can also order MH meds; internists and family practice physicians do so fairly often. I saw our FP today for  my sore hand and raised the subject; my impression was she'd be uncomfortable writing kids' MH prescriptions, but is quite at home with adults. I'd think that most surgeons and Ob-Gyn physicians would be less likely to write RXs for many of these drugs without consulting another physician who's used to the meds and their side effects. The standard anti-anxiety drugs would be an exception, of course, and perhaps they might treat a patient with relatively mild depression.

Whenever I saw a patient with significant depression or other major MH issues I put in a call to the psychiatrists.

So who is available to treat this youngster?
Mostly likely his pediatrician.

I didn't know much about pediatric mental health issues. I found an online paper titled "Strategies to Support the Integration of Mental Health into Pediatric Primary Care" from an organization I at first thought was part of the NIH. Then I Googled it and realized the National Institute for Health Care Management wasn't governmental, but a non-profit. The Executive Summary of "Strategies" stated up to one in five children and adolescents in the U.S. experience MH issues with 50% of all lifetime mental disorders being seen by age 14.

The issue for Pediatrics is there aren't very many psychiatrists who specialize in kids; so three ideas have been suggested: telemedicine for remote Pediatric practices; co-locating a pediatric psychiatrist in a large Peds practice or collaborative care via what's called the "medical home model." But for Pediatrics in general, the integration of MH care into primary care is desperately needed; again there just aren't enough Peds therapists to see all the youngsters with MH issues.

I'll get back to the DSM in my next post; its history is interesting and its latest version, to be published in May 2013, has caused a lot of controversy.