Mental Health Consult

Continuity of care for the 18-year-old male who told Dr. Lillian M. Beard about his depression requires collaboration with colleagues, but coordinating that care takes resources. Who is in charge of ensuring care?

“This is where teams come in,” says Dr. April Barbour, associate professor of medicine and chief of general internal medicine George Washington University, Washington. “Because it doesn’t necessarily need to be the psychiatrist. A discharge coordinator could serve that role and send that information back.”

“I agree. And then we come back to the next thing: Who’s going to pay for the team? Who’s going to manage the team? Also, the other thing – with any team, someone’s got to be the quarterback – someone has to make sure or verify that it happened,” says Dr. Lorenzo Norris, cohost of Mental Health Consult, and assistant professor of psychiatry and behavioral sciences at George Washington University.

“When you are treating mental illness, you need a team-based approach so that you can look at everything that is going on. If you are strictly algorithmic based, there are going to be fatal errors,” Dr. Norris says. “It doesn’t reduce down to that level.”

Continuity of care for the 18-year-old male who told Dr. Lillian M. Beard about his depression requires collaboration with colleagues, but coordinating that care takes resources. Who is in charge of ensuring care?

“This is where teams come in,” says Dr. April Barbour, associate professor of medicine and chief of general internal medicine George Washington University, Washington. “Because it doesn’t necessarily need to be the psychiatrist. A discharge coordinator could serve that role and send that information back.”

“I agree. And then we come back to the next thing: Who’s going to pay for the team? Who’s going to manage the team? Also, the other thing – with any team, someone’s got to be the quarterback – someone has to make sure or verify that it happened,” says Dr. Lorenzo Norris, cohost of Mental Health Consult, and assistant professor of psychiatry and behavioral sciences at George Washington University.

“When you are treating mental illness, you need a team-based approach so that you can look at everything that is going on. If you are strictly algorithmic based, there are going to be fatal errors,” Dr. Norris says. “It doesn’t reduce down to that level.”

Continuity of care for the 18-year-old male who told Dr. Lillian M. Beard about his depression requires collaboration with colleagues, but coordinating that care takes resources. Who is in charge of ensuring care?

“This is where teams come in,” says Dr. April Barbour, associate professor of medicine and chief of general internal medicine George Washington University, Washington. “Because it doesn’t necessarily need to be the psychiatrist. A discharge coordinator could serve that role and send that information back.”

“I agree. And then we come back to the next thing: Who’s going to pay for the team? Who’s going to manage the team? Also, the other thing – with any team, someone’s got to be the quarterback – someone has to make sure or verify that it happened,” says Dr. Lorenzo Norris, cohost of Mental Health Consult, and assistant professor of psychiatry and behavioral sciences at George Washington University.

“When you are treating mental illness, you need a team-based approach so that you can look at everything that is going on. If you are strictly algorithmic based, there are going to be fatal errors,” Dr. Norris says. “It doesn’t reduce down to that level.”

When a patient presents with depression, how is it possible to determine whether serious mental illnesses such as first-episode psychosis are unfolding? In this video, Dr. Lillian M. Beard, who practices pediatrics in Silver Spring, Md., discusses the case of an 18-year-old male with thoughts of suicide whose situation was exacerbated by poor continuity of care.

“From the crisis center, [the patient] was admitted to a hospital, but there wasn’t a follow-up,” Dr. Beard says.

This discussion between Dr. Beard; Dr. Lorenzo Norris, cohost of Mental Health Consult and medical director of psychiatric and behavioral services at George Washington University Hospital, Washington; and Dr. David Pickar, adjunct professor of psychiatry at Johns Hopkins University, Baltimore, explores how these kinds of circumstances might affect the patient’s case, as well as other clinical considerations that should help guide referral.

When a patient presents with depression, how is it possible to determine whether serious mental illnesses such as first-episode psychosis are unfolding? In this video, Dr. Lillian M. Beard, who practices pediatrics in Silver Spring, Md., discusses the case of an 18-year-old male with thoughts of suicide whose situation was exacerbated by poor continuity of care.

“From the crisis center, [the patient] was admitted to a hospital, but there wasn’t a follow-up,” Dr. Beard says.

This discussion between Dr. Beard; Dr. Lorenzo Norris, cohost of Mental Health Consult and medical director of psychiatric and behavioral services at George Washington University Hospital, Washington; and Dr. David Pickar, adjunct professor of psychiatry at Johns Hopkins University, Baltimore, explores how these kinds of circumstances might affect the patient’s case, as well as other clinical considerations that should help guide referral.

When a patient presents with depression, how is it possible to determine whether serious mental illnesses such as first-episode psychosis are unfolding? In this video, Dr. Lillian M. Beard, who practices pediatrics in Silver Spring, Md., discusses the case of an 18-year-old male with thoughts of suicide whose situation was exacerbated by poor continuity of care.

“From the crisis center, [the patient] was admitted to a hospital, but there wasn’t a follow-up,” Dr. Beard says.

This discussion between Dr. Beard; Dr. Lorenzo Norris, cohost of Mental Health Consult and medical director of psychiatric and behavioral services at George Washington University Hospital, Washington; and Dr. David Pickar, adjunct professor of psychiatry at Johns Hopkins University, Baltimore, explores how these kinds of circumstances might affect the patient’s case, as well as other clinical considerations that should help guide referral.

When an adolescent presents with a history of sudden decline in academic performance, be sure to consider serious mental illness.

According to Dr. David Pickar, a psychiatrist and former (retired) director of intramural research at the National Institute of Mental Health, 90%of cases – particularly of schizophrenia – occur between the ages of 16 and 24 years.

“As a scientist, I’ve spent my career thinking about that, but for the primary care doc, if the family comes in and reports that their kid was a good student, and he’s now terrible,” first-episode psychosis should be considered, said Dr. Pickar, who produced a documentary short film describing how to recognize schizophrenia and psychosis. In this video, Dr. Pickar also explains how the use of marijuana also can precipitate psychosis in some people with a genetic predisposition to the illness.

When an adolescent presents with a history of sudden decline in academic performance, be sure to consider serious mental illness.

According to Dr. David Pickar, a psychiatrist and former (retired) director of intramural research at the National Institute of Mental Health, 90%of cases – particularly of schizophrenia – occur between the ages of 16 and 24 years.

“As a scientist, I’ve spent my career thinking about that, but for the primary care doc, if the family comes in and reports that their kid was a good student, and he’s now terrible,” first-episode psychosis should be considered, said Dr. Pickar, who produced a documentary short film describing how to recognize schizophrenia and psychosis. In this video, Dr. Pickar also explains how the use of marijuana also can precipitate psychosis in some people with a genetic predisposition to the illness.

When an adolescent presents with a history of sudden decline in academic performance, be sure to consider serious mental illness.

According to Dr. David Pickar, a psychiatrist and former (retired) director of intramural research at the National Institute of Mental Health, 90%of cases – particularly of schizophrenia – occur between the ages of 16 and 24 years.

“As a scientist, I’ve spent my career thinking about that, but for the primary care doc, if the family comes in and reports that their kid was a good student, and he’s now terrible,” first-episode psychosis should be considered, said Dr. Pickar, who produced a documentary short film describing how to recognize schizophrenia and psychosis. In this video, Dr. Pickar also explains how the use of marijuana also can precipitate psychosis in some people with a genetic predisposition to the illness.

Serious mental illness can present slowly and in ways that might not look serious, which is why primary care physicians would do well to educate themselves about what psychosis looks like.

The problem, according to Dr. David Pickar, psychiatrist and former (retired) intramural research director for the National Institute of Mental Health, is the lack of information about recognizing the signs and symptoms, and about proper interventions.

“Knowing about it is enormously important for all docs,” Dr. Pickar says. “What’s fascinating is many of the first breaks occur, not necessarily quietly, but can be a little insidious. They can be brought to primary care. It is not uncommon. With serious mental illness, particularly schizophrenia, 1% of the population has it. That makes it a very common disorder.”

Serious mental illness can present slowly and in ways that might not look serious, which is why primary care physicians would do well to educate themselves about what psychosis looks like.

The problem, according to Dr. David Pickar, psychiatrist and former (retired) intramural research director for the National Institute of Mental Health, is the lack of information about recognizing the signs and symptoms, and about proper interventions.

“Knowing about it is enormously important for all docs,” Dr. Pickar says. “What’s fascinating is many of the first breaks occur, not necessarily quietly, but can be a little insidious. They can be brought to primary care. It is not uncommon. With serious mental illness, particularly schizophrenia, 1% of the population has it. That makes it a very common disorder.”

Serious mental illness can present slowly and in ways that might not look serious, which is why primary care physicians would do well to educate themselves about what psychosis looks like.

The problem, according to Dr. David Pickar, psychiatrist and former (retired) intramural research director for the National Institute of Mental Health, is the lack of information about recognizing the signs and symptoms, and about proper interventions.

“Knowing about it is enormously important for all docs,” Dr. Pickar says. “What’s fascinating is many of the first breaks occur, not necessarily quietly, but can be a little insidious. They can be brought to primary care. It is not uncommon. With serious mental illness, particularly schizophrenia, 1% of the population has it. That makes it a very common disorder.”

Dr. Lillian M. Beard discusses the challenges of getting reimbursed for providing mental and behavioral health care within her pediatric practice. Addressing her patients’ mental health needs can take three of her regular appointment times. “I am never adequately reimbursed for the time that it really takes,” she says. Having a mental health specialist on site might be one possibility, but is this model feasible? In this video, Dr. Beard, Dr. April Barbour, and Dr. Lorenzo Norris explore ways primary care and psychiatry can work together to provide patients with the best possible care.

Dr. Lillian M. Beard discusses the challenges of getting reimbursed for providing mental and behavioral health care within her pediatric practice. Addressing her patients’ mental health needs can take three of her regular appointment times. “I am never adequately reimbursed for the time that it really takes,” she says. Having a mental health specialist on site might be one possibility, but is this model feasible? In this video, Dr. Beard, Dr. April Barbour, and Dr. Lorenzo Norris explore ways primary care and psychiatry can work together to provide patients with the best possible care.

Dr. Lillian M. Beard discusses the challenges of getting reimbursed for providing mental and behavioral health care within her pediatric practice. Addressing her patients’ mental health needs can take three of her regular appointment times. “I am never adequately reimbursed for the time that it really takes,” she says. Having a mental health specialist on site might be one possibility, but is this model feasible? In this video, Dr. Beard, Dr. April Barbour, and Dr. Lorenzo Norris explore ways primary care and psychiatry can work together to provide patients with the best possible care.

The role of primary care physicians in recognizing patients with behavioral and mental health problems is critical, psychiatrist Dr. David Pickar says. “That is what you do for a living. You find out these things. I want to make sure that the primary care physician [who] may be watching this understands he or she is not just the first line, but he or she has good skills at observing what is going on with the patient.” The primary care physician also has a relationship with the patient, psychiatrist Dr. Lorenzo Norris says. “The patient is more inclined to listen to [the primary care physician] than to just some random specialist.” In this video, Dr. Pickar and Dr. Norris discuss the importance of communicating about shared patients – not through electronic medical records, but through true dialogue.

The role of primary care physicians in recognizing patients with behavioral and mental health problems is critical, psychiatrist Dr. David Pickar says. “That is what you do for a living. You find out these things. I want to make sure that the primary care physician [who] may be watching this understands he or she is not just the first line, but he or she has good skills at observing what is going on with the patient.” The primary care physician also has a relationship with the patient, psychiatrist Dr. Lorenzo Norris says. “The patient is more inclined to listen to [the primary care physician] than to just some random specialist.” In this video, Dr. Pickar and Dr. Norris discuss the importance of communicating about shared patients – not through electronic medical records, but through true dialogue.

The role of primary care physicians in recognizing patients with behavioral and mental health problems is critical, psychiatrist Dr. David Pickar says. “That is what you do for a living. You find out these things. I want to make sure that the primary care physician [who] may be watching this understands he or she is not just the first line, but he or she has good skills at observing what is going on with the patient.” The primary care physician also has a relationship with the patient, psychiatrist Dr. Lorenzo Norris says. “The patient is more inclined to listen to [the primary care physician] than to just some random specialist.” In this video, Dr. Pickar and Dr. Norris discuss the importance of communicating about shared patients – not through electronic medical records, but through true dialogue.

Primary care physicians have the potential to detect “distress” diagnoses and mental or behavioral disorders in most patients who come to the office, noted Dr. Lawrence “Bopper” Deyton, senior associate dean for clinical public health and professor of medicine and health policy at George Washington University.

If one embraces the Acceptable Care Act’s priorities of improving quality of care, reducing cost, and improving patient satisfaction, “Aren’t we at the cusp of a reimbursement system that should reward for that?” he asks.

Kennedy Forum policy director Lauren Alfred says there’s only so much that can be done. “Then at some point, we have to talk about collaborative care ... and where we’re going to bring specialists into the equation.”

In this video, Dr. Deyton and Ms. Alfred discuss how much mental health care primary care physicians should be asked to shoulder – and when such care should be more collaborative.

Primary care physicians have the potential to detect “distress” diagnoses and mental or behavioral disorders in most patients who come to the office, noted Dr. Lawrence “Bopper” Deyton, senior associate dean for clinical public health and professor of medicine and health policy at George Washington University.

If one embraces the Acceptable Care Act’s priorities of improving quality of care, reducing cost, and improving patient satisfaction, “Aren’t we at the cusp of a reimbursement system that should reward for that?” he asks.

Kennedy Forum policy director Lauren Alfred says there’s only so much that can be done. “Then at some point, we have to talk about collaborative care ... and where we’re going to bring specialists into the equation.”

In this video, Dr. Deyton and Ms. Alfred discuss how much mental health care primary care physicians should be asked to shoulder – and when such care should be more collaborative.

Primary care physicians have the potential to detect “distress” diagnoses and mental or behavioral disorders in most patients who come to the office, noted Dr. Lawrence “Bopper” Deyton, senior associate dean for clinical public health and professor of medicine and health policy at George Washington University.

If one embraces the Acceptable Care Act’s priorities of improving quality of care, reducing cost, and improving patient satisfaction, “Aren’t we at the cusp of a reimbursement system that should reward for that?” he asks.

Kennedy Forum policy director Lauren Alfred says there’s only so much that can be done. “Then at some point, we have to talk about collaborative care ... and where we’re going to bring specialists into the equation.”

In this video, Dr. Deyton and Ms. Alfred discuss how much mental health care primary care physicians should be asked to shoulder – and when such care should be more collaborative.

Primary care physicians want a collaborative approach to mental and behavioral health care, according to Dr. April Barbour, director of general internal medicine and the primary care residency program at George Washington University, Washington. “That’s a lot of what we teach and train our residents ... and this allows us to truly treat the whole patient.”

Training models are out there, but the question of whether funding is available to keep these models viable is an issue.

“Every professional is going to look to be compensated for his or her time and input,” explains Dr. Lillian M. Beard, physician director of Children’s Pediatricians and Associates, Silver Spring, Md. “We have to look at mind, body, spirit. It’s the whole thing.”

In this video, Dr. Barbour, Dr. Beard, and psychiatrists Dr. Lorenzo Norris and Dr. David Pickar discuss how to make primary care practices responsive to patients in ways that are both holistic and cost effective.

Primary care physicians want a collaborative approach to mental and behavioral health care, according to Dr. April Barbour, director of general internal medicine and the primary care residency program at George Washington University, Washington. “That’s a lot of what we teach and train our residents ... and this allows us to truly treat the whole patient.”

Training models are out there, but the question of whether funding is available to keep these models viable is an issue.

“Every professional is going to look to be compensated for his or her time and input,” explains Dr. Lillian M. Beard, physician director of Children’s Pediatricians and Associates, Silver Spring, Md. “We have to look at mind, body, spirit. It’s the whole thing.”

In this video, Dr. Barbour, Dr. Beard, and psychiatrists Dr. Lorenzo Norris and Dr. David Pickar discuss how to make primary care practices responsive to patients in ways that are both holistic and cost effective.

Primary care physicians want a collaborative approach to mental and behavioral health care, according to Dr. April Barbour, director of general internal medicine and the primary care residency program at George Washington University, Washington. “That’s a lot of what we teach and train our residents ... and this allows us to truly treat the whole patient.”

Training models are out there, but the question of whether funding is available to keep these models viable is an issue.

“Every professional is going to look to be compensated for his or her time and input,” explains Dr. Lillian M. Beard, physician director of Children’s Pediatricians and Associates, Silver Spring, Md. “We have to look at mind, body, spirit. It’s the whole thing.”

In this video, Dr. Barbour, Dr. Beard, and psychiatrists Dr. Lorenzo Norris and Dr. David Pickar discuss how to make primary care practices responsive to patients in ways that are both holistic and cost effective.

Dr. David Pickar and Dr. Lillian M. Beard address the importance of flagging ADHD in the classroom, addressing family resistance to treatment, and situations that might call for the involvement of other mental health colleagues.

“I find a lot of resistance [to the ADHD diagnosis], particularly among African American families,” says Dr. Beard, physician director, Children’s Pediatricians and Associates, Silver Spring, Md.

“An untreated ADHD kid is difficult for the teacher, but it is toughest on the kid,” says Dr. Pickar, adjunct professor of psychiatry at Johns Hopkins University, Baltimore. “Families may not hear it all, but a doctor pays a lot of attention to what the teacher is saying about that child in the classroom.”

Dr. David Pickar and Dr. Lillian M. Beard address the importance of flagging ADHD in the classroom, addressing family resistance to treatment, and situations that might call for the involvement of other mental health colleagues.

“I find a lot of resistance [to the ADHD diagnosis], particularly among African American families,” says Dr. Beard, physician director, Children’s Pediatricians and Associates, Silver Spring, Md.

“An untreated ADHD kid is difficult for the teacher, but it is toughest on the kid,” says Dr. Pickar, adjunct professor of psychiatry at Johns Hopkins University, Baltimore. “Families may not hear it all, but a doctor pays a lot of attention to what the teacher is saying about that child in the classroom.”

Dr. David Pickar and Dr. Lillian M. Beard address the importance of flagging ADHD in the classroom, addressing family resistance to treatment, and situations that might call for the involvement of other mental health colleagues.

“I find a lot of resistance [to the ADHD diagnosis], particularly among African American families,” says Dr. Beard, physician director, Children’s Pediatricians and Associates, Silver Spring, Md.

“An untreated ADHD kid is difficult for the teacher, but it is toughest on the kid,” says Dr. Pickar, adjunct professor of psychiatry at Johns Hopkins University, Baltimore. “Families may not hear it all, but a doctor pays a lot of attention to what the teacher is saying about that child in the classroom.”

Primary care physicians are on the front lines for diagnosing and prescribing to treat attention-deficit/hyperactivity disorder in children. In this video, Dr. David Pickar and Dr. Lillian M. Beard discuss what primary care physicians should know to feel confident when diagnosing and treating ADHD.

“[The first time] you see a patient with ADHD respond to stimulants, you see it is lifesaving … [the result] takes your breath away,” Dr. Pickar says.

Primary care physicians are on the front lines for diagnosing and prescribing to treat attention-deficit/hyperactivity disorder in children. In this video, Dr. David Pickar and Dr. Lillian M. Beard discuss what primary care physicians should know to feel confident when diagnosing and treating ADHD.

“[The first time] you see a patient with ADHD respond to stimulants, you see it is lifesaving … [the result] takes your breath away,” Dr. Pickar says.

Primary care physicians are on the front lines for diagnosing and prescribing to treat attention-deficit/hyperactivity disorder in children. In this video, Dr. David Pickar and Dr. Lillian M. Beard discuss what primary care physicians should know to feel confident when diagnosing and treating ADHD.

“[The first time] you see a patient with ADHD respond to stimulants, you see it is lifesaving … [the result] takes your breath away,” Dr. Pickar says.