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Trained or not, family doctors and pediatricians are on the front lines of mental health care

, Nashville Tennessean


Here are some tips to help recognize a mental health crisis and how to help. Ayrika L Whitney, The Tennessean

When a sick kid steps into the pediatrician’s office, it could be for just about anything: an ear infection, a twisted ankle or an upset stomach. And sometimes, behind all those outward symptoms, there is something deeper that needs attention.

Pediatricians and family doctors have long served a crucial but largely undefined role in American mental health care, diagnosing and treating depression and anxiety in addition to everyday physical injuries and common diseases.

But amid rising concern about mental health and gun violence in America, experts say these primary care doctors could do more to spot red flags among their patients.

Dr. Nathaniel Clark, chief medical officer at Vanderbilt Behavioral Health, described the task of primary care doctors as challenging: They are the Swiss army knives of medicine, expected to do a little of everything, but also a front-line defense in a growing mental health crisis.

“As health care has become more complicated, the pressure on family care providers to do it all has increased exponentially,” Clark said.

“But what’s also happened is there is a growing awareness of how common behavior health disorders are. And the challenge for family practitioners and pediatricians is partly that, while they have excellent training, it’s not necessarily focused on behavioral health.”

Psychiatrists are in short supply throughout Tennessee and nationwide, so the vast majority of mental health disorders are diagnosed and treated by primary care doctors. Nearly all these doctors studied mental health at one point because a psychiatry rotation is mandatory in most medical schools. But once school is done, the amount of continuing education they get in the field of mental health varies broadly.

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But now a relentless drumbeat of deadly mass shootings — including Nashville’s own Waffle House shooting — has spurred a nationwide desire to prioritize mental health and expanding training options for primary care doctors.

In Tennessee, the governor’s office has led an initiative called “Building Strong Brains,” funded with $1.25 million from state lawmakers the past two years, including grant funding for mental health education for pediatricians and other doctors.

Training primarily focuses on the link between early-age childhood trauma, officially known as “adverse childhood experiences,” and teenagers with behavioral and physical health problems.

In addition to the Building Strong Brains program, the Tennessee Chapter of the American Academy of Pediatrics has launched the Behavioral Healthcare in Pediatrics training program, or BeHIP, in which doctors learn from real cases of children with complex mental health diagnoses.

The program started small, uniting about five pediatricians in the state’s northeast corner, but is now expanding into Knoxville. Organizers hope to expand it statewide, said Dr. Michelle Fiscus, BeHIP medical director.

Participating doctors discuss challenging mental health cases within Tennessee’s children protective services system, Fiscus said. That experience should make the doctors’ interaction with other patients with depression or attention deficit disorders “much less intimidating.”

“It makes perfect sense that a pediatrician could be a great resource and manager of behavioral health concerns for our patients,” Fiscus said.

Fiscus, a Franklin pediatrician, said she envisioned the BeHIP training program in part because of an uncertainty she felt when treating mental health patients years ago. Too many other doctors, she said, still feel the same way.

“Across the state, it’s not the biggest topic that pediatricians want to treat,” Fiscus said. “Because it’s so large and so broad, sometimes they don’t know where to start when it comes to mental health.”

Jessica Bliss contributed to this report.

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