PCPs quarterback mental healthcare

May 1, 2013

They might not recognize the early symptoms, such as depression, anxiety, sleep disturbance, and paranoia, of serious mental illness

Much of the mental healthcare in this country is managed by the primary care physician (PCP).

As health insurers move to patient-centered medical homes and accountable care organizations, the PCP’s role will become even more important because he or she will become the “quarterback” for that patient’s physical and emotional care, according to William Wood, MD, PhD, chief medical officer of behavioral health for Amerigroup Tennessee.

A recent study, however, found that they might not recognize the early symptoms, such as depression, anxiety, sleep disturbance, and paranoia, of serious mental illness. Researchers from McGill University in Canada found that for almost 50% of patients between the ages of 14 to 25 received their first diagnosis of serious psychosis in the emergency room.

Wayne W. Lindstrom, PhD, says that this is also the case in the United States. “Most PCPs are not prepared to assess for a mental illness or an addiction disorder,” he says.

Dr. Wood says it is difficult for a PCP to recognize a mental illness because he or she has such a limited time to spend with each patient and many of the symptoms could also point to a physical illness or temporary stress.

“Some physicians are really fantastic at recognizing behavioral health issues and some are not. But when you talk about Medicaid patients, you will look at a group of PCPs who are very good at it because the majority of their patients have some type of behavioral health issue whether it is substance abuse, depression or post traumatic stress disorder from living in a violent communities,” says Christina Severin, president of Network Health in Massachusetts.

Even if the PCP recognizes that the patient has a behavioral health condition, they might not be able to access the behavioral healthcare system to get treatment. This is one reason why 70% to 75% of prescriptions for depression and anxiety disorders are written in the primary care arena.

“We’ve got a number of challenges on the primary care front. If the Affordable Care Act fills its promise, we will potentially overcome them with new integration and collaborative care models between mental health and primary care,” says Lindstrom, who is president and CEO of Mental Health America.

These models include:

Hiring or contracting clinicians, case managers, and peer specialists with expertise in behavioral health to practice in primary care settings to assist with crisis intervention, case consultations, assessments, appropriate interventions, collaborative care, and referrals when appropriate;

Hiring or contracting with primary care physicians to offer integrated collaborative care in behavioral health treatment setting;

Offering primary care consultations with behavioral health specialists through telephone or the internet, particularly in rural and frontier areas of the country;

Merging community mental health centers (CMHCs) with federally qualified health Centers (FQHCs); and

Integrating behavioral healthcare treatment, planning, and funding entities in the planning and implementation of healthcare homes, accountable care organizations, and healthcare exchanges.

“People have to be treated in a holistic way,” Severin says. “We have members in our health plan who are all unique individuals and they all have issues that deal with oral health, mental health and physical health. We must address these in the context of the patient, the family and the community.”