During an annual physical examination with a family practitioner, the medical staff takes blood pressure and pulse readings, notes medications taken, measures height and weight and notes the reason for the visit. Rarely do family physicians ask questions about patient mental health.
Since a mental health disorder does not necessarily reveal physical ailments like one would see in a typical emergency room, people dealing with a mental health disorder are among the walking wounded due to medical passiveness of present conditions. A person could have depression, anxiety or even schizophrenia and most likely won’t mention symptoms due to the stigma of mental health disorders, treatment time commitments and costs and sometimes insufficient acknowledgement by medical professionals. To quote the American Academy of Family Physicians, “Improving mental health treatment requires enhancing the ability of the primary care physician to screen, treat and appropriately manage the psychiatric care given to patients.”
Mental health disorders and mental health services have also been frequent topics in the news recently. The suicide of actor and comedian Robin Williams who had been suffering from depression for many years shocked many, and prompted a national discussion about depression and suicide. It also brought awareness to the large number of other people who suffer from depression and other mental health disorders, and the insensitivity of many who simply do not understand the illnesses. The stigma surrounding mental health exists as an unspoken attitude that perpetuates disorders with “craziness.”
The American Academy of Family Physicians published a position paper advocating mental health care for patients. The paper read:
While psychiatric professionals are an essential element of the total health care continuum, the majority of patients with mental health issues will continue to access the health care system through primary care physicians. The desire of patients to receive treatment from their primary care physicians, or at least to have their primary care physicians more involved in their care, has been repeatedly documented. To achieve the goals of enhancing mental health treatment with primary care physicians, the AAFP advocates the following:
- Continued emphasis of mental health care through clinical rotations in psychiatric inpatient and outpatient centers and continued exposure to psychiatric diagnosis and management via the resident continuity clinic
- Continued support for maintenance and expansion of state, federal and private insurance funding for mental health care. Adequate funding for inmate mental health care and military veterans and their spouses
- Parity in payment to primary care physicians for mental health care
- Primary care physicians are increasingly locating psychologists, psychiatric social workers and even psychiatrists in the primary care physician’s office. Request adequate funding of mental health care to assure continued availability to patients
- Supports the development of new treatment strategies to improve the number of patients receiving adequate treatment and follow-up through both primary care and mental health specialty care providers
The presence of a mental health care specialist in a primary physician’s office would have many patient benefits including integrated medical records and billing, universal screening for depression and substance abuse and a focus on treatment approaches that encourage shared patient care. AAFP said that these arrangements also create opportunities for the family physician to personally introduce the patient to the behavioral health specialist and for “meet-in-the-hall” consults and shared appointments for more complex cases.
Treating the body and the mind
Treatment of the body and treatment of the mind have long been separate provinces treated by clinicians in different practices and buildings. Many patients referred to psychologists or psychiatrists do not always show up for appointments and receive adequate treatment. Psychiatrists and psychologists are often perceived as people to avoid; they are also expensive and usually require multiple visits. If those clinicians are part of the practice and are introduced to the patient by the family physician, it is infinitely more patient-friendly and successful treatment is more likely.
Patrice Whistler, MD, MPH, FAAP describes Andrew’s case:
“Andrew was brought in by his parents who were worried that his ADHD (attention deficit hyperactivity disorder) medications were becoming less effective. I learned there had been recent changes to the parent’s custody agreement and Andrew’s father was going through a second divorce. Andrew had become sullen, argumentative and less willing to do homework. His grades were faltering as well. My practice has a behavioral health specialist on site that was able to join Andrew, his parents and me within five minutes, after a simple page. I introduced the family to the counselor, quickly established an agenda and then left to see my next patient.”
“The counselor was able to meet with the family for 30 minutes the first day. Afterward, the family established a routine of coming for monthly joint appointments. These typically consisted of 30 to 50 minutes sessions with the counselor during which I would join them for 10 to 15 minutes to provide medication management, a brief physical exam and care coordination. Within a few months, the family stressors had been addressed and Andrew had rebounded in school. His parents were pleased to report that he was back to being the lively 10-year-old boy they knew and loved.”
The body and the mind are not separate entities; each relies completely on the other to function. Diagnosing and treating a mental health disorder in its early stages has long been proclaimed as good practice. We now have therapeutic treatment for mental health disorders and ever improving medications to use in conjunction with therapy.
Sadly, the stigma remains and it is only education that will help people realize that mental health disorders may affect anyone at any time. Patients suffering from mental disorders are aware of the stigma and it is one of many reasons they avoid seeking help, from their primary physician or clinician.
Written by Veronica McNamara, Sovereign Health Group writer