Can Primary Care Physicians Address the Behavioral Health Crisis?

It's a good start


The reality is we are in a mental health crisis. This has been compounded by a two year pandemic, lock downs, provider unavailability, and extreme stress in an already stretched thin system.


Source: https://www.medpagetoday.com/opinion/second-opinions/97868



In a recent Senate Finance Committee hearing, U.S. Surgeon General Vivek Murthy, MD, MBA, said, "We are on the verge of beating back one public health crisis in COVID-19, only to see another grow in its place ... We have the opportunity and the responsibility to make change happen now."

Murthy was referring to what we as a nation face today: A growing and undeniable behavioral health crisis. A proven solution to remedy this is to better integrate behavioral health services into primary care settings and realign payment and delivery systems to help physicians meet the growing and diverse behavioral health needs of their patients.


The reality is Primary Care physicians do tend to see their patients more than a specialist, but mental health care is complicated.



I see mental health care as a three legged stool (most of the time). One leg is the possibility of medication (which is NOT always the answer or effective). The second is a provider (helper/oversee the care). This can be anyone from a general practitioner (primary care), psychiatrist, psychologists, social worker, mental health worker, nurse practitioner, nurse, family member, co worker, mentor, teacher and/or a priest. This list is not exhaustive and inclusive of everyone that can actually make an impact on someone in a mental health crisis and also, it does not mean that everyone on the list is qualified to help. The third leg is the person in need. Like any illness or disease the patient is a very critical component of the overall care. This is particularly critical in mental health. You have to be an active member of therapy, counseling, group, zoom meetings or whatever type of treatment type you are getting.


You have to put in the work.

According to the CDC, in 2020, suicide was among the top 5 leading causes of death for people ages 10-64. Suicide was the second leading cause of death for people ages 10-14 and 25-34. Some groups have higher suicide rates than others. Among the highest rates are American Indian/Alaska Native and White populations, veterans, people who live in rural areas, and young adults who identify as lesbian, gay, or bisexual.


Provisional data from the Centers for Disease Control and Prevention (CDC)'s National Center for Health Statistics indicate that there were an estimated 100,306 drug overdose deaths in the United States during the 12-month period ending in April 2021, an increase of 28.5 percent from the 78,056 deaths during the same period the year before. To combat this crisis, Secretary Becerra announced the release of the new HHS Overdose Prevention Strategy, designed to increase access to the full range of care and services for individuals who use substances that cause overdose, and their families. Even before the COVID-19 pandemic, mental health challenges were common, with 1 in 5 adults experiencing a mental illness in any given year. Mental health challenges were the leading cause of disability and poor life outcomes in young people, with up to 1 in 5 children ages 3 to 17 in the United States having a mental, emotional, developmental, or behavioral disorder.


Source: https://www.hhs.gov/about/news/2022/03/02/secretary-becerra-kicks-off-national-tour-to-strengthen-mental-health.html


These are very scary statistics and it is only getting worse. Politicians can promise the world and deliver on nothing. One of the biggest issues right now is there are not enough providers for the amount of people seeking mental health assistance. I can tell you that I have heard of waits up to 3 to 6 months for getting an therapist that takes insurance to participate on a zoom call (not even in person). That is a very big problem. A lot can go wrong during that time. Emergency Rooms and Urgent Cares are being flooded with people in crisis and they are generally not properly staffed or qualified to treat the issues and it is rare that someone is admitted. The person has to show they are a immediate harm to themselves or others with no shades of grey. Trust me when I tell you it is very easy to get around being admitted if you do not want to be. It can become a play on words and if you are a non voluntary patient, it is really a crap shoot if you will get a needed bed. It is very scary.


Currently, access to comprehensive behavioral health services is unevenly distributed throughout the U.S., and roughly two-thirds of primary care physicians are unable to connect their patients to outpatient mental health services in a timely manner. As a result, many primary care physicians have assumed a leading role in managing these more complex behavioral health challenges. Still, they are doing so without the support of an adequate physician payment system that reflects these important responsibilities. The other problem is that if they take the lead on mental health, their practice is not set up to bill mental health therapeutic time. See the article below. To me, this is the least of the problems in the system. If we are going to integrate primary care with mental health, we need to increase provider continuing education, exposure, and qualifications. BUT, and this is a big BUT, any care is better than no care. There are plenty of primary care physicians that may even be better than an available psychiatrist because perhaps they know you better or you have a long-standing relationship with them. The need is there. The question that remains is will the politicians, insurance companies, APA, and treatment centers get on board with the expansion of provider capabilities and breadth of expertise and treatment abilities.

Currently, access to comprehensive behavioral health services is unevenly distributed throughout the U.S., and roughly two-thirds of primary care physicians are unable to connect their patients to outpatient mental health services in a timely manner. As a result, many primary care physicians have assumed a leading role in managing these more complex behavioral health challenges. Still, they are doing so without the support of an adequate physician payment system that reflects these important responsibilities. The other problem is that if they take the lead on mental health, their practice is not set up to bill mental health therapeutic time. See the article below.



To me, this is the least of the problems in the system. If we are going to integrate primary care with mental health, we need to increase provider continuing education, exposure, and qualifications. BUT, and this is a big BUT, any care is better than no care.


There are plenty of primary care physicians that may even be better than an available psychiatrist because perhaps they know you better or you have a long-standing relationship with them. The need is there. The question that remains is will the politicians, insurance companies, APA, and treatment centers get on board with the expansion of provider capabilities and breadth of expertise and treatment abilities.

Let's keep our fingers crossed.


Source: https://www.aafp.org/about/policies/all/mental-health-services.html

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