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Psychiatric specialist helps get primary care doctors involved in mental health treatment

It was a different time 33 years ago when Chicago native Dr. David L. Kaye arrived in Buffalo to treat young patients with mental health challenges at Women & Children’s Hospital. Pediatricians back then focused much of their practices on aches, pains and giving shots to prevent infectious diseases.

“They used to see all the ‘itises,’ ” Kaye recalled. “Those itises are much less common today, so what’s walking in the door are well child visits and kids with chronic conditions: asthma, obesity and mental health concerns. And mental health concerns are now the most common chronic problem seen in primary care.”

A shortage of psychiatrists of all kinds – including child psychiatric specialists like Kaye – has driven more patients with mild to moderate mental illness, whether temporary or chronic, into the offices of pediatricians and primary care doctors.

Kaye said the shift has led to concerns and questions among those doctors: “I wasn’t trained to do this type of work.” “I don’t know how to do it.” “I can handle this, but how do I manage these patients in a busy office – and how do I get paid for it?”

“This isn’t like dealing with a kid who comes in with a cold or a sore throat,” Kaye said. “That takes a few minutes. Mental health treatment takes more time, and what should these doctors do if they find out their patient needs a referral for more intensive care?”

These concerns, and a growing number of mental health cases, led to the creation of Child and Adolescent Psychiatry for Primary Care, or CAP PC, a collaborative of mental health professionals from the University at Buffalo, University of Rochester, Upstate Medical Center in Syracuse, Columbia University in New York City and North Shore/Long Island Jewish Hospital in Bethpage. Kaye directs the organization, designed to help primary care providers better treat patients with mental illness through workshops, phone consultations and other means.

CAP PC has joined forces with the Peter and Elizabeth C. Tower Foundation, REACH Institute in New York and the Institute for Healthcare Communication in New Haven, Conn., to bring a workshop to Buffalo later this year designed to improve the way health professionals communicate when it comes to mental health. It will run from 8 a.m. to 5 p.m. Nov. 7 at the UB Clinical and Translational Research Center; several conference call case study training sessions will follow. The program costs $300, and continuing medical education credits will be given. For more information and an application, visit healthcarecomm.org, email tdurbin@healthcarecomm.org or call (217) 621-6867.

Kaye focuses on education in his roles with CAP PC and as professor of psychiatry and vice chairman of academic affairs in the Psychiatry Department at the UB School of Medicine and Biomedical Sciences. He also has a private practice in Amherst.

“I have tremendous respect and admiration for my colleagues in primary care,” said Kaye, 63, who lives in North Buffalo with his wife, Emily Ets-Hokin, a psychologist. “I feel they are my soulmates who are willing and able to get involved with this.”

Q. Why is this work important?

A lot of parents and a lot of kids look increasingly at primary care for answers to behavioral health issues, and primary care is in a position to pick a lot of things up earlier, to maybe help with prevention … and also to provide some treatment. (Primary care doctors can access CAP PC at cappcny.org or toll-free at (855) 227-7272.)

Q. What were you seeing that precipitated the idea to establish a program?

There’s much more awareness of mental health. There’s still stigma but there’s much less stigma. There’s much more of a broad sense that this is a real problem. Secondly, you look at the epidemiology. The research shows there are a huge number of kids with mental health needs. … Some of the data suggests that well less than 50 percent of kids with a mental health problem get any kind of treatment and the vast majority of that is low-intensity, short duration. Maybe 10 to 20 percent of kids who could use treatment are getting what anyone would say is reasonable treatment. This is another leg of the argument why primary care should be, and is, getting involved with mental health. The public needs primary care to be involved. We’ve asked these folks to get up to speed so that they feel good about taking care of mild to moderate problems.

Q. How will the Communication Skills for Child Health Care Professionals workshop come off?

It’ll be very interactive, hands-on, with the goal of somebody leaving with new skills.

Q. What are the best pieces of advice you give to a pediatric health professional when it comes to helping to treat children with behavioral health conditions?

They’re trusted. They’re known. They can be a huge support. They can be specifically helpful with referrals. Depending on their level of comfort and expertise, they may be able to do some interventions themselves. They’re in a prime position to make a huge difference in kids and families’ lives.

email: refresh@buffnews.com

On the Web: Dr. David L. Kaye talks more about mental health care and where parents can find helpful resources at refresh.buffalonews.com.