Mental health treatment challenges in primary care

Peter S. Jensen, MD, child and adolescent psychiatrist and founder and board chair of The REACH Institute, highlights the critical challenges in pediatric mental health care and the practical tools available to primary care providers. With a growing demand for mental health services, Jensen emphasizes the need for better training, screening tools, and reimbursement structures to support pediatricians in addressing conditions such as ADHD, anxiety, and depression.

Through The REACH Institute, Jensen and his team have trained more than 8,000 pediatricians and family practitioners over the past 15 years. Despite this progress, significant barriers remain.

“The biggest challenge is finding the time and space in a busy practice to actually introduce the topic and follow up on the topic,” Jensen says. “Another major issue is that primary care physicians don’t get enough training during residency, so they often lack hands-on experience in treating conditions like depression or anxiety."

To help bridge this gap, Jensen points to a variety of freely available, evidence-based screening tools that can be easily implemented in primary care settings. “The good news is that there are now a handful of free, effective screening checklists available to primary care providers, that are kind of like checklists,” he explains. These include the M-CHAT for autism spectrum disorder, the Vanderbilt rating scale for ADHD, and the PSC-17, an improved version of the Pediatric Symptom Checklist.

“PSC 17 lets you separate out the child who might have more attention problems, or might anxiety or depression problems or maybe other kinds of behavioral difficulties,” Jensen notes. “There’s a parent version and a teen version. So these can be transformative.”

Beyond screening, Jensen stresses the importance of reimbursement for these tools, which can make their adoption more feasible for busy pediatric practices. "Many insurance companies, including Medicaid, provide reimbursement for these screening tools, making them more accessible for primary care practices," Jensen says. "They take just a minute or two but offer valuable insights that save time and guide treatment decisions."

He also highlights other widely used assessments, such as the PHQ-9 for depression and the SCARED tool for anxiety screening. By integrating these tools into electronic health records and practice workflows, pediatricians can take a significant step toward improving mental health care for children and adolescents.

Quotations edited in text for clarity.