SAN FRANCISCO — When primary care physicians head home at the end of the day in one New York practice, mental health providers reopen the doors to children and families who need their help.
Offering the after-hours office space to mental health providers has helped physicians ensure that their patients get the care they need, allowed mental health providers to build their practices, and offered children and families a way to find affordable mental health care, William Bryson-Brockmann, Ph.D., said in a poster presentation at the annual meeting of the American Academy of Pediatrics.
A full-time pediatric psychologist and a full-time behavioral pediatrician in the academic-based practice cannot handle all the requests for psychological services generated by their colleagues' patients. The practice also gets referrals from community pediatricians who do not offer mental health care in their own practices.
So the practice started offering low-cost office space to other mental health providers in 1993, and now has one psychologist and four clinical social workers who rent space for $20 per hour. Several exam rooms have desks and enough space for the chairs necessary to accommodate a family, said pediatric psychologist Bryson-Brockmann of Winthrop-University Hospital, Mineola, N.Y.
These mental health providers all work in the school system and see most of their private practice clients after 5 p.m., when the pediatric practice is closed. Some offer services on weekends or on weekdays after school, although they occasionally have difficulty reserving office space before 5 p.m., he said.
“We can usually find somebody for every family” who needs mental health care, and the pediatricians in the practice appreciate that they can refer patients to mental health providers with whom they're familiar, Dr. Bryson-Brockmann said.
Before this arrangement, it was much harder to connect patients with mental health services, he said. As many as 17% of 5- to 9-year-old children in pediatric practices may have mental health problems, a 2000 study suggested.
Numerous barriers prevent many children from getting mental health care, Dr. Jane M. Foy said in a separate session at the meeting. When a child is seen by a mental health provider, the child's pediatrician may not have a relationship with that provider.
“Finding access to a child psychiatrist is nearly impossible in many areas of the country,” said Dr. Foy, chair of the AAP's Task Force on Mental Health and professor of pediatrics at Wake Forest University, Winston-Salem, N.C. “Eighty percent of children who need mental health services simply never get them.”
A survey of the five mental health providers who rent after-hours space in Dr. Bryson-Brockmann's practice found that they appreciated the easy access to pediatricians and the flexibility provided by the arrangement.
They set their own hours, purchase their own malpractice insurance, and handle their own records and billing, which minimizes any burden on the pediatric office staff, reported Dr. Bryson-Brockmann and his coauthor, Dr. Ronald V. Marino, also of the hospital.
“By making mental health services more easily accessible in the pediatric office, [we hope that] families will access this needed service,” Dr. Bryson-Brockmann said.
For the most part, the mental health providers are not in insurance plans. Because of their low overhead costs, however, the charge to patients typically is not much greater than copays in some managed-care mental health models. Some families reject this arrangement initially, but will often return when they can't find adequate insurance-based services, he said.
Three of the therapists work primarily with adolescent patients. Each of the five has developed an area of expertise, such as anxiety, eating disorders, adjustment reactions, or dysfunctional families.