It is no surprise to anyone working in primary care or mental health that access to child psychiatrists and other mental health experts is very difficult.  Here at the VCCYF, our own waitlist has grown to many many months despite everyone working on all cylinders.  Frustrations by parents, clinicians, and (yes) those of us here too, are rising and there is no quick fix in the foreseeable future. 

In the meantime, there are a number of things we can all do to ensure that Vermont youth are getting the highest level of assessment and treatment given the current shortage.

1. Maximize therapy and counseling.   For many conditions, effective psychotherapy can be extremely good at reducing psychiatric symptoms. Many primary care clinicians may be aware that their patient is “in counseling,” but are the families really getting as much out of it as they could?  To ensure that they are, clinicians and/or parents can examine these parameters.
   1. Frequency.  How often is counseling happening?  For a child who is struggling, once every two weeks or less often just isn’t enough.
   2. Type.  Is the counselor using evidenced-based techniques such as cognitive behavior therapy (CBT)?  If not, could they be incorporated or is it worth considering a trial of CBT somewhere else?
   3. Parent involvement.  Are parents an active part of the treatment or does the door close and the parents kept at bay?  Even high functioning parents can benefit from parental guidance and such efforts can make huge improvements in child behavior.
2. Take the first or next step in your own office.  Everyone’s comfort and expertise levels varies for different types of medical problems, but for children just starting the mental health treatment journey or presenting with relatively straightforward conditions, the potential benefits of avoiding delay and starting the process in house may outweigh the risks.  Consider a choice to advance your knowledge and comfort for one problem area where you have hesitated in the past.
3. Consult a child psychiatrist informally.  Most physicians here at the VCCYF and elsewhere are aware of the current crisis and are happy to listen to a brief case summary by a primary care clinician if contacted by phone or email.  This blog also has a mechanism for questions.  There may not always be an easy recommendation to give, but if there is we will share it.
4. Contact your government representative.  Let your representative know that mental health care needs to be a medical priority.  Psychiatry, like primary care and other time-based rather than procedure-based specialties, has been disproportionately under-reimbursed. The current statistics on physician specialty choice, practice location, and patient access to care all reflect these past priority choices.  As Vermont considers major changes in health care, there may be a prime opportunity to bring needed balance into our system.
5. Assess and treat parents.  This one is especially for you family physicians, who are well positioned to help parents with their own anxiety, depression, and substance use. Doing so can often induce a positive chain reaction that benefits the entire family.
6. (for those affiliated with some FQHCs) Take advantage of our telepsychiatry service.  Currently, child psychiatry fellows working at FQHCs in St. Johnsbury, Castleton, Richford, and Plainfield have allotted time to do child psychiatry consultations via videoconferencing technology with minimal wait after screening instruments are completed.  Primary care clinicians need to be affiliated with those FQHCs. 

These steps may not be enough to meet fully the need in front of us but can certainly help make the most of the limited resources currently available.  Here at the VCCYF, we are very concerned about this issue too and are working hard to increase access in Vermont and beyond.