We are well aware of the shortage of mental health specialists available for children in this country and the resultant shift for pediatricians to do more and more of the mental health diagnosis and prescribing given that shortage. While we have published studies on models of integration between psychologists and psychiatrists based in primary care offices or offering consultations to them on a regular basis, we have not had a good grasp of just what all of us do in our practices when it comes to diagnosing mental health problems and prescribing medications for these problems.
That is until Mayne et al. (peds.2015-2974) performed a retrospective review of almost 300,000 children in 43 US primary care practices over a five and a half year period to look at similarities and variations across these practices in which 15% of children had a mental health diagnosis and 14% of children were prescribed medication for that diagnosis. That being said there was a wide range of prescribing that occurred across the practices in terms of types of medication and how many medications per child.
The presence or absence of psychiatrists in a community also made a difference, with those without psychiatrists prescribing more often, but this was not the only factor influencing the variability. To find out others, check out this study and compare it to your own in regard to the prevalence of mental health disorders diagnosed and prescribing patterns. Should we be more consistent as a profession in how we approach children with mental health issues? This study may make you at least more aware of a need to reduce some of the wide-ranging variability described in this national study.