Barriers to managing child and adolescent mental health problems: a systematic review of primary care practitioners' perceptions.
BACKGROUND
Mental health problems are common and typically have an early onset. Effective treatments for mental health problems in childhood and adolescence are available, yet only a minority of children who are affected access them. This is of serious concern, considering the far-reaching and long-term negative consequences of such problems. Primary care is usually the first port of call for concerned parents so it is important to understand how primary care practitioners manage child and adolescent mental health problems and the barriers they face.


OBJECTIVE
To ascertain primary care practitioners' perceptions of the barriers that prevent effective management of child and adolescent mental health problems.


METHODS
A systematic review of qualitative and quantitative literature in a primary care setting.


METHODS
A database search of peer-reviewed articles using PsycINFO, MEDLINE(®), Embase, and Web of Science, from inception (earliest 1806) until October 2014, was conducted. Additional studies were identified through hand searches and forward-citation searches. Studies needed to have at least one search term in four categories: primary care, childhood/adolescence, mental health, and barriers.


RESULTS
A total of 4151 articles were identified, of which 43 were included (30 quantitative studies and 13 qualitative studies). The majority of the barriers related to identification, management, and/or referral. Considerable barriers included a lack of providers and resources, extensive waiting lists, and financial restrictions.


CONCLUSIONS
The identification of a broad range of significant barriers highlights the need to strengthen the ability to deal with these common difficulties in primary care. There is a particular need for tools and training to aid accurate identification and management, and for more efficient access to specialist services.
School of Psychology and Clinical Language Sciences, University of Reading, Reading.
Doireann
D
O'Brien
School of Psychology and Clinical Language Sciences, University of Reading, Reading.
Kate
K
Harvey
School of Psychology and Clinical Language Sciences, University of Reading, Reading.
Jessica
J
Howse
School of Psychology and Clinical Language Sciences, University of Reading, Reading.
Tessa
T
Reardon
School of Psychology and Clinical Language Sciences, University of Reading, Reading.
Cathy
C
Creswell
D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration* / Q000592:standards; D001291:Attitude of Health Personnel; D002648:Child; D002662:Child Health Services / Q000458:organization & administration* / Q000592:standards; D019538:Health Care Surveys; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration; D015397:Program Evaluation; D036301:Qualitative Research; D012017:Referral and Consultation / Q000458:organization & administration*; D006113:United Kingdom / Q000453:epidemiology
access to health care; barriers; child mental disorders; general practice; primary health care