WEDNESDAY, Feb. 8, 2023 (HealthDay News) — Primary care doctors aren’t just in the physical health business anymore: Americans are increasingly turning to them for mental health care, too, according to a new study.
Looking at Americans’ primary care visits between 2006 and 2018, researchers found a 50% increase in the proportion of visits dealing with mental health issues. This figure fell from just under 11% of visits to 16% at the end of the study period.
The reasons are unclear, experts say, but it’s not just a matter of mental health problems becoming more common: Over the same period, according to other studies, the national rate of mental health mental has increased by about 18%.
Instead, it appears that primary care physicians are taking more responsibility for diagnosing and, in some cases, treating mental health issues.
“I think this study really highlights the importance of primary care in our country,” said lead researcher Dr. Lisa Rotenstein, medical director of population health at Brigham and Women’s Hospital in Boston.
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It also means primary care physicians need resources to ensure patients diagnosed with mental health issues receive the best treatment, she said.
The results – published in the February issue of the journal Health Affairs — are based on an ongoing government survey that collects information about Americans’ office medical care.
Rotenstein’s team analyzed records from nearly 110,000 primary care visits, which represents about 3.9 million appointments nationwide. A visit was considered to have “addressed a mental health issue” if the record indicated that was the reason for the appointment, or if the doctor had diagnosed a mental health issue at the time.
Overall, the proportion of visits falling into this category increased by almost 50% between 2006 and 2018.
The study can’t pinpoint the reasons – whether it’s doctors doing more mental health screenings or patients bringing up mental health symptoms more often, for example.
But it’s likely a combination of these and other factors, Rotenstein said.
Dr. Robert Trestman, chairman of the American Psychiatric Association’s Council on Health Systems and Funding, agrees.
He noted that the Affordable Care Act – better known as “Obamacare” – was passed during the study period, which reduced the ranks of the uninsured nationwide.
At the same time, the stigma around mental health has eased.
“People are more comfortable talking about mental health and addiction,” said Trestman, who was not involved in the study. “It’s very important that the stigma is reduced.”
But, the two experts said, systems need to be in place to help primary care physicians treat mental health — and get patients the treatment they need.
This includes adequate insurance reimbursement. It also means that primary care providers must be able to refer patients to a mental health specialist if needed, to ensure they receive the best care.
Systematic screening for depression, for example, is recommended for adults and adolescents.
“But we need the ability to process them,” Trestman said, “and right now we don’t have that.”
He said it was important for primary care physicians to “proactively build relationships” with mental health professionals in their community, to facilitate referrals of patients when needed.
But, Trestman and Rotenstein said, it’s also a big challenge in the many parts of the country that lack mental health care providers.
“Telehealth” services that connect patients and providers remotely can help to some extent, Trestman said. But that does not solve the shortage of mental health specialists.
And then there are racial and ethnic disparities. Rotenstein’s team found that, compared to their white counterparts, black and Hispanic Americans were 40% less likely to have a mental health condition treated during a primary care visit.
Rotenstein said future studies need to dig deeper into the reasons, including whether doctors are less likely to screen patients of color or whether differences in insurance coverage are a barrier.
Trestman said doctors’ unconscious biases and communication barriers could play a role. So one solution might be to not just grow the health workforce, but to make sure they include more providers of color.
Regarding patient messaging, Rotenstein pointed to another finding of the study: mental health issues were more likely to be addressed when patients saw their established primary care physician – someone who knows them. , in other words.
At a time when many Americans use walk-in clinics for health care as needed, that’s important, Rotenstein said. That underscores one of the benefits of having a regular supplier you know, she said.
The National Alliance on Mental Illness has an overview of common mental health issues.
SOURCES: Lisa Rotenstein, MD, MBA, medical director, Population Health, Brigham and Women’s Hospital Primary Care Center of Excellence, Boston; Robert Trestman, MD, PhD, Chairman, Council on Health Care Systems and Financing, American Psychiatric Association, Washington, DC; Health Affairs, February 2023