Barriers to mental health referral from pediatric primary care settings

To examine the frequency of barriers to mental health referral according to pediatric primary care physician (PCP) report and to identify factors related to perceptions of referral barriers for patients with managed care coverage.

Data from a national sample of 319 PCPs were examined. Comparisons were made concerning the frequency of PCP-reported barriers to mental health referrals for patients with fee-for-service versus managed care coverage. The relationship between relevant factors (eg, practice structure, interdisciplinary office staff, availability of community mental health resources) and perceived barriers was examined for managed care coverage.

Barriers to mental heath referrals were more commonly reported for those with managed care versus fee-for-service coverage for 11 of the 12 barriers assessed (P < .0001). For patients with managed care coverage a high availability of community mental health resources was associated with fewer perceived barriers among physicians (P < .0001).

Our findings suggest that PCPs perceive barriers to mental health referrals as common challenges when addressing psychosocial concerns. Referral barriers were more commonly reported for patients with managed care coverage. Increasing the availability of community mental health resources was identified as an important variable in facilitating appropriate referrals.