The COVID-19 pandemic and the killing of George Floyd are further stressing the already strained U.S. mental health care system. Primary care doctors train to treat common mental health problems, and they can help alleviate this strain on the system.
Mental health issues on the rise
In a national survey [pdf] of primary care patients from June 2020, 33% reported having trouble with feelings of isolation/loneliness. Thirty percent reported anxiety or depression, and 13% reported an addiction related to the pandemic. Nearly 75% of patients reported the killing of George Floyd and related events contributed to their emotional distress. Of those who reported that racism has impacted their health, 70% sought help from their primary care doctor.
These are clearly major mental health challenges facing patients and the health care system. Two responses from the same survey are particularly illustrative of just how big the need can be:
“I wish there was easier, more affordable and trustworthy access to mental health care during the pandemic.”
“Information about the virus is on the TV constantly, depending on who you listen to you get different stories about the virus. It is very confusing and frustrating. It contributes to the anxiety while being isolated.”
Prior to the pandemic, there were already concerns about a rising incidence of mental health issues associated with a number of factors, including increasing social media use. With the social isolation that has resulted from the pandemic, and the growing reliance on the internet and social media that have largely replaced face-to-face interactions, there are even further concerns about meeting the mental health needs of the public.
Primary care and mental health
Unfortunately, many people are not aware of the role their primary care doctor can play in supporting their mental health. Some media outlets and celebrities have contributed to the lack of knowledge, even as they advocate for de-stigmatizing mental health issues. For example, Lady Gaga has spoken widely about, and driven more attention to, mental health. But, when giving an interview with Oprah, she stated that antidepressants should only be prescribed by psychiatrists.
Primary care doctors can treat common mental health conditions like those people are experiencing during this pandemic. To achieve the vision of access to mental health care for everyone, we need primary care doctors to ask about, and encourage patients to discuss, their mental health.
What we know about mental health treatment in primary care
Competency in diagnosing and treating common mental health conditions is a required part of their training [pdf]. This includes prescribing medications for many mental health conditions. In fact, primary care doctors prescribe half (51%) of the medications for depression and anxiety. Psychiatrists prescribe only one-third (36%). And more visits for mental health conditions take place in primary care offices than in psychiatry offices (45% vs. 25%). (Robert Graham Center Analysis of Medical Expenditure Panel Survey data (2008-2017)).
Primary care provides comprehensive care. Many people with mental health problems also have other medical conditions. Because primary care doctors treat the whole person, they can address the impact of emotional or behavioral problems on other medical conditions, such as diabetes, and vice versa.
Integrating mental health into primary care
People who feel stigmatized by mental illness may be more comfortable being cared for in a primary care clinic rather than a specialty mental health clinic.
Many primary care doctors are integrating mental health services into their practice care team. This approach has proven effective for both children and adults. In these integrated clinics, patients have access to medication and counseling in the same location. Innovative policies should support these interdisciplinary teams. These might include payment incentives to better manage depression and other mental health conditions.
Many primary care doctors are not able to refer their patients to outpatient mental health services. Psychiatrists are much less likely to accept insurance, including Medicaid and Medicare. Most rural communities do not have a psychiatrist within reasonable distance to provide care. Even in cities with more psychiatrists, most are booked up weeks in advance. Practicing in nearly every county in the U.S., primary care doctors provide access to patients who may not have access to a psychiatrist.
To fully address the mental health needs during the current COVID-19 crisis and beyond, we need the expertise and support of primary care doctors. They can provide patients with the access to mental health care that they deserve.
** Gold, Vagnini, Gilchrist, and Wong are with the Farley Health Policy Center. Jetty, Jabbarpour, Petterson, and Westfall are with the Robert Graham Center.
Stephanie Gold
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