The Pediatrician: The First in Line for Mental Health Support

Pediatricians are typically the first stop for parents concerned about their child’s mental health.  Families build long-term, trusting relationships with their pediatricians, so it makes sense that they turn to us for help navigating a journey that is all too often full of obstacles and challenges.  


 Pediatricians are not only the initial option for children and adolescents with mental health conditions, they are often the only option. Finding a pediatric psychiatrist or psychologist within commercial insurance networks is often impossible, and those that do accept insurance typically have extremely long waiting lists.  This is less than ideal for a child in imminent need of mental health treatment.  Although commercial payers are increasingly providing more coverage for mental health services, small panel sizes and limited coverage duration continue to make access to care a challenge.  Currently, up to 20% of children in the US have a mental health or behavioral disorder; unfortunately, many do not receive treatment due to these barriers to care.


Thus, pediatricians often find themselves independently managing patients with psychiatric conditions - including major depressive disorder, ADHD, and bipolar disorder.  They not only prescribe medications but provide counseling as well.  In most cases, there is nowhere else to send these young patients in need of treatment.  This dual function of care can be daunting for pediatricians, as most of us come out of residency with only a few weeks of pediatric psychiatry training – if any at all. With the numerous black box warnings and age-dependent risks associated with psychiatric drugs in children, prescribing these medications can be a nerve-racking position to be in.  

But, as pediatricians, our first and foremost obligation is to the patient, so we balance caring for our patients against practicing medicine that we haven’t had formal training in. We become counselors.  We prescribe medications that are outside of our comfort zone. We do the best we can to help our young patients receive the treatment they need.


The suicide rate has gone up 28% in the US in the last 20 years, and while this trend affects Americans in every age group, it is the second leading cause of death for teens and adolescents.  It’s time to change how we handle and provide care for children and adolescents with mental health conditions in the US.  Institutional barriers preventing access to psychiatrists and therapists need to be removed more aggressively.


Over the last 5 years, there has been an eruption of innovation in the mental health space, with the emergence of apps for counseling, coaching, and meditation.  Consumers can receive live or store-and-forward teletherapy in the comfort of their own homes.  As entrepreneurs strive to solve these access issues, a greater focus on providing solutions for children and families is clearly needed.