Mayo-led group will focus on children's mental health

A new collaboration between the Minnesota Department of Human Services and Mayo Clinic will bring much-needed training to doctors who are overwhelmed with pediatric patients seeking care for mental health conditions.

The $1.7 million partnership also will pay for a phone service that doctors can call to obtain prescribing and treatment advice. The idea has been in the works for years as a way to help Minnesota cope with a severe shortage of child psychiatrists.

Pediatricians and family practice doctors often find themselves on the front lines when it comes to dealing with their patients' mental health problems. Like many states, Minnesota has few psychiatrists trained to treat children. There are only 81 of these specialists in the entire state. That means young patients often must rely on general physicians for the help they need. But family doctors typically don't have the expertise to properly deal with mental health conditions.

Peter Jensen, a Mayo Clinic psychiatrist who will lead the new statewide training effort, said no one expects physicians to take on suicidal children or kids with extremely complex conditions. But after about 25 hours of voluntary training spread over six months, he said, they should be able to handle mild to moderate mental health issues.

"They need to be able to do a great job with ADHD, a great job with depression, a great job with kids with anxiety problems and a great job with kids who have problems that are a little more complicated, say have lots of aggression," he said.

Jensen said physician unease over treating these conditions has lead to situations in which some children receive no care at all, or are under-treated. In other cases doctors have over-prescribed powerful psychotropic medications.

Each scenario is problematic. But Jensen said over-prescribing is especially troubling.

"Part of the reason for alarm is that these are not benign medications," he said. "Certainly in adults they're linked to the onset of diabetes and obesity, metabolic problems. And we're seeing some of these same issues in children."

Over-prescribing appears to be especially rampant in Minnesota's foster care system, according to the Minnesota Department of Human Services, which just completed an analysis of medication trends. Commissioner Lucinda Jesson said the use of antipsychotics and mood stabilizers is too high.

"Children who are in our foster care system are five times more likely to be prescribed these heavy-duty, psychotropic medications than children with mental health diagnoses just in our regular Medicaid program," Jesson said. "That's a problem."

Starting in August, the department will require doctors who treat Medical Assistance patients to call its new phone service, if they plan to use certain psychotropic medications at doses that are outside the recommended guidelines. For doctors who don't treat Medical Assistance patients the prescribing guidelines will be voluntary.

The agency also is touting the free phone service, which is another component of its collaboration with Mayo, as a way to help physicians connect their patients with counseling. Jesson said multiple studies have shown more than 60 percent of children who receive psychotropic drugs don't receive any follow-up counseling that could teach them how to better manage their thoughts and emotions.

The call center will attempt to connect physicians and patients with resources in their own community first. But if that's not possible, the partnership hopes to use video technology to link patients with mental health experts in the Twin Cities and elsewhere.

Sue Abderholden, executive director of NAMI Minnesota, an affiliate of the National Alliance on Mental Illness, doesn't see any downside to the state's and Mayo's training effort.

"You already have a majority of the mental health medications being written by primary care physicians, not by child psychiatrists," Abderholden said.

"By bringing in some people who are experts I think we might see less dosages, or more effective dosages, you know the best medication for that particular illness and symptoms. So, I think there would be less guesswork to be honest."

Over the next two years, Mayo Clinic hopes to provide mental health training to about a tenth of the state's pediatricians and family doctors. To expand its training program geographically, Mayo has entered contracts with Essentia Health, Sanford Health and PrairieCare. Each will provide a training site for physicians in their region.

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