Difficulty Obtaining Behavioral Health Services for Children: A National Survey of Multiphysician Practices

Thank you for objectively quantifying difficulties faced in obtainment of behavioral health services for children experiencing depression, anxiety, other mental illness and/or substance abuse disorders. Through exploration of National Survey of Healthcare Organizations and Systems (NSHOS) data, the authors were able to review accessibility of behavioral health services across multiphysician practices as a function of ownership structure and practice attributes. As an undergraduate who actively volunteers for the warmline on my large midwestern campus, I recognize challenges often faced by students in securing mental health therapist and/or counselor consultation due to high clinical demands. However, I was quite taken aback that over 85% of multipractice practices, in your study, found it very challenging to acquire behavioral healthcare services for their pediatric patients. Furthermore, the ongoing COVID-19 pandemic has resulted in further challenges resulting in significant delays in securing pediatric behavioral health specialist care.1 As such, behavioral health specialists are needed more than ever for the care of children.

In reviewing your study, several thoughts and questions crossed my mind. Your team employed analyses using 2017-2018 NSHOS data. I found it noteworthy that you compared your findings to the 2004-2005 Community Tracking Study (CTS) Physician Survey.2 Importantly, nearly 15 years had passed between administration of the 2004-2005 CTS Physician Survey and 2017-2018 NSHOS. It is striking that such a paucity of nationally representative behavioral health access data were available. From a primary care perspective, what policies could be implemented to increase and expand nationally representative behavioral health data collection and surveillance? Additionally, we need to recognize that significant population- and healthcare-related shifts can occur over the course of nearly two decades.

Second, given my warmline volunteer work, I am cognizant of the need to differentiate between need for and access to child and adult behavioral health services. Third, you hypothesized that (1) overall most US practices would have difficulty obtaining pediatric behavioral health services and (2) health system-owned practices and those with alternative payment models might have less difficulty accessing pediatric behavioral health services. While statistically significant differences did emerge (e.g., greater access among Medicaid ACO participants) in pediatric access to medication advice and evidence-based psychotherapy, I am curious about the clinical significance of these findings. There is clearly much work needed to greatly expand behavioral health service access for children across the US.

Overall, I very much enjoyed reviewing your study as your team addresses an important topic in need of continuous investigation. Access to consistent and comprehensive pediatric behavioral health services are critical now and in the years to come.

References
1. Shah K, Mann S, Singh R, Bangar R, Kulkarni R. Impact of COVID-19 on the mental health of children and adolescents. Cureus. 2020;12(8):e10051. doi: 10.7759/cureus.10051
2. Cunningham PJ. Beyond parity: primary care physicians' perspectives on access to mental health care. Health Aff (Millwood). 2009;28(3):w490-501. doi: 10.1377/hlthaff.28.3.w490.