Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community

Abstract

Pediatricians and other primary care clinicians* caring for children traditionally have focused their attention on meeting the health care needs of individual children they see in their offices and clinics. However, effective care of the growing number of children and families who are experiencing chronic medical and mental disorders will also require a “population” health perspective. Many policy statements from the American Academy of Pediatrics (AAP) have pointed to the importance of the population perspective in providing and improving pediatric health services.1–10 From this perspective, all members of a community are affected by the health of its individual members. For children, mental health resides not solely within the child but within the web of interactions that connect the child, the family and school, health and other child service systems, and the neighborhood and community in which the child lives.11 This is not to deny that biology is a determinant of mental health and mental illness; rather, biological factors interact with the psychosocial environment to result in mental health, mental illness, and recovery from mental illness. Primary care clinicians who are interested in enhancing mental† health services in their community will need to form partnerships. Key partners for a community mental health advocacy effort include other primary care clinicians, developmental-behavioral pediatricians, adolescent health specialists, the local public mental health agency, representatives of the mental health care provider community (eg, psychiatrists, psychologists, social workers, substance abuse counselors, psychiatric nurse practitioners), community mental health activists including parents and youth, school system representatives, early childhood educators, Early-Intervention (EI) system representatives, representatives of the child protective and juvenile justice systems, and the local department of public health. Primary care clinicians cannot feasibly pursue the strategies that follow in the absence of such partnerships. In every region of the United … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu