Integrating Mental Health with Primary Care
By Katie Gibas CNY/YNN August 10, 2012
UNITED STATES -- Estimates show at least six out of every ten people who come into a doctor's office have some sort of mental or behavioral issue. But experts say the system is failing those patients.
"There's a growing body of evidence that shows that even those mild conditions really impact people's well-being and health," said Dr. John Bartlett, the senior project adviser of the Primary Care Initiative of the Mental Health Program at the Carter Center.
Dr. David Satcher, the former surgeon general, added, "They have a life expectancy that's on average 25 years lower than the rest of the population. So they need to have comprehensive care, and they often don't get it."
About half of people with depression are only getting treatment in the primary care setting.
Only 30 percent get better.
"Part of the reason that people who are treated for depression in primary care don't get better is because they're not really followed up really well. As I said, Primary care doctors have a 15 minute visit and at least for part of that 15 minutes, they have to fill out the documentation so that the practice can get reimbursed with the insurance company. So maybe they have 12 minutes," said Bartlett.
In contrast, mental health specialists often spend an hour at a time with a patient. They'll get a comprehensive look at a patient's history, discuss current life situations, provide counseling and help the patient make the necessary behavioral changes. And most importantly, they'll follow up with the patient regularly.
In order to receive the quality of care necessary, behavioral and mental health experts are calling for a complete integration of primary care and mental and behavioral health services.
"It reduces the stigma that's associated with mental illness. That's critical. It makes it easier for people to seek treatment. It improves access. People don't have to be sent from here to somewhere else when you have integration. And number three, it improves the quality of care," said Satcher.
While there are initial investments and challenges to implementation, they say integrating primary and behavioral health care will pay off in the long run.
"Not only does their depression get better. But their diabetes gets better too. That's the real payoff. The real payoff is that the costs associated with chronic medical conditions when they're associated with depression, anxiety, risky drinking, go way down when those problems are adequately addressed in the primary care setting," said Bartlett.
A handful of places have been experimenting with integration, and so far, things seem to be paying off. Experts say the biggest challenges to implementation are merging the two cultures and changing attitudes about how to give the best care.
The Affordable Care Act is expected to help address some of the structural and reimbursement challenges to integrating primary care and behavioral health care.