Mental and behavioral health: Clinical guidance and practice resources
Mental health concerns are common, and family physicians are key to early identification.
Mental and behavioral health conditions are among the most common concerns patients bring to primary care. Each year, tens of millions of adults and adolescents experience challenges such as depression, anxiety, serious mental illness, or substance use, and many turn first to their family physician for support.¹ These concerns affect individuals and families in every community, underscoring the importance of compassionate, evidence-based care.
This page provides practical resources to help you identify, assess, and manage mental and behavioral health conditions in everyday practice. These tools support early intervention, reduce stigma, and empower you to connect patients with the care and treatment they need.
Guidelines and recommendations
Clinical practice guidelines
Key recommendations
From the updated guidelines developed by the American Academy of Pediatrics and endorsed by the American Academy of Family Physicians:ADHD: Clinical practice guidelines for the diagnosis, evaluation and treatment of ADHD in children and adolescents (Endorsed, April 2020)
Any child aged 4–18 years who presents with academic or behavioral problems and symptoms of inattention, hyperactivity or impulsivity should be evaluated for ADHD.
The diagnosis of ADHD should be based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, with information obtained from parents/guardians, teachers and other school and mental health clinicians involved in the child’s care.
Alternative causes of the behavior should be ruled out.
A child being evaluated for ADHD should also be assessed for other conditions that might coexist with ADHD, including emotional, behavioral, developmental and physical conditions.
Children with ADHD should be managed following the principles of the chronic care model and the medical home.
Preschool-aged children (aged 4-5 years) should be treated with behavior therapy as the first line of treatment. Methylphenidate may be prescribed if the behavior interventions do not provide significant improvement and there is moderate-to-severe continuing disturbance in the child’s function.
Elementary school-aged children (aged 6-11 years) should be treated with the FDA-approved medications for ADHD and /or behavioral therapy.
Adolescents (aged 12-18 years) should be treated with FDA-approved medications, with assent, for ADHD and may be treated with behavioral therapy.
Medication doses should be titrated to achieve maximum benefit with minimum adverse effects.
Co-morbid conditions should be diagnosed and managed appropriately.
Screening and treatment of depression following acute coronary syndrome (ACS)
(Developed by the AAFP, March 2019)
The guideline, Screening and Treatment of Depression Following Acute Coronary Syndrome, was developed by the American Academy of Family Physicians and approved by the Board of Directors in March 2019. The guideline was published in the American Family Physician on June 14, 2019.
Key Recommendations:
A standardized depression screening tool (e.g. BDI-II, HADS, GDS, PHQ) should be used to screen for depression in patients who have recently experienced an ACS event.
In patients who screen positive for depression, further assessment should be performed to confirm the diagnosis of depression.
Antidepressant medication, preferably selective serotonin reuptake inhibitors (SSRIs), serotonin-nonepinephrine reuptake inhibitors (SNRIs) and/or cognitive behavioral therapy should be prescribed to improve symptoms of depression in patients who have a history of ACS and have been diagnosed with depression. Tricyclic antidepressants have multiple adverse events, including potential cardiotoxicity and should not be used in patients with heart disease.
U.S. adults aged 18 years and older reported experiencing some form of mental illness in 2024.
Clinical preventive service recommendations from the USPSTF
The USPSTF recommends anxiety screening for asymptomatic patients aged 8 to 18 years, citing moderate net benefit and minimal harms. Evidence is insufficient to assess the balance of benefits and harms for children aged 7 years and younger. Follow-up diagnostic assessment is essential after a positive screen.
Read the full recommendation for more information.
The USPSTF recommends screening all adults, including pregnant, postpartum and older adults, for major depressive disorder, citing a moderate net benefit. Positive screens should prompt diagnostic follow-up and appropriate care. Current evidence remains insufficient to recommend for or against routine suicide risk screening in asymptomatic adults.
Read the full recommendation for more information.
The USPSTF recommends screening adolescents aged 12 to 18 years for major depressive disorder, citing a moderate net benefit. Evidence is insufficient to assess the benefits and harms of screening younger children or for suicide risk in children and adolescents. Positive screens should be followed by diagnostic assessment and access to appropriate care.
Read the full recommendation for more information.
According to the USPSTF, current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment in asymptomatic adults 65 and older. Some screening tools show moderate sensitivity and specificity, but no clinical trials demonstrate improved outcomes from screening. Clinicians should remain alert to early signs of cognitive decline and evaluate as appropriate.
Read the full recommendation for more information.
The USPSTF recommends screening adults 18 and older, including pregnant women, for unhealthy alcohol use and providing brief behavioral counseling for those who screen positive. These interventions show moderate benefit in reducing risky drinking behaviors. For adolescents aged 12 to 17 years, the evidence is currently insufficient to assess the benefits and harms of screening and counseling.
Read the full recommendation for more information.
The USPSTF recommends clinicians provide or refer pregnant and postpartum individuals at increased risk of perinatal depression to counseling interventions, such as cognitive behavioral therapy or interpersonal therapy. These approaches show moderate net benefit in preventing perinatal depression, especially in those with a history of depression, current symptoms or social risk factors. Other preventive strategies, including pharmacologic and non-counseling interventions, lacked sufficient evidence.
Read the full recommendation for more information.
Implementation Tools
Practice Hacks: Behavioral Health Integration
Watch this Practice Hack for strategies to integrate the PHQ-9 screening into your clinical practice. This includes steps you can take to support your patients who may need additional behavioral health resources or follow-up.