By Deborah Jeanne Sergeant
Eighty percent of people with a behavioral health disorder see a primary care provider at least annually, according to the Primary Care Collaborative.
Rather than relying on patients to self-refer to mental healthcare providers, PCPs are becoming gatekeepers for mental health than ever before.
The US Preventative Service Task Force recommends PCPs screen for depression in adults in children who are older than 12. This has become especially important in light of the effects of the pandemic.
“Between 2019 and 2022, depression and anxiety have gone up 25%,” said Kimberly Fortin, licensed clinical social worker in private practice in Weedsport. “That’s a really big number in a short period of time. That in itself should be enough that people should say this is a potential epidemic that’s building; everyone should be screened.”
After screening for depression, PCPs can refer patients as needed to seek mental healthcare. Often, the screening tools are a short set of questions that the patient can answer via a paper or digital survey or a few questions the PCP asks to assess mental health. While not a comprehensive mental health evaluation, a screening can help patients consider their mental health and feel freer to talk about it as a routine part of their preventative healthcare.
Fortin said that the screening questionnaires typically result in “scores” that can give the PCP guidance on whether to refer patients to mental healthcare. Fortin believes that these screenings should be a part of every person’s annual physical. This may help dispel any lingering stigma about seeking mental healthcare and encourage patients who have mental health concerns to seek professional help.
Whether PCPs use screening tools is another matter.
“I think it depends on the doctor,” Fortin said. “There was a big push a few years back to do trainings with doctors on the tools.”
According to the US Bureau of Labor Statistics, 20% of healthcare providers left healthcare during the pandemic, meaning that those who remain in healthcare are stretched thinner than ever. Taking time to include one more screening — however important it may be — could prove very challenging.
“PCPs are overwhelmed and are doing their best to screen when they can,” said Julienne Capria, psychiatrist with Oswego Health. “They might not be equipped with time or knowledge to screen as much as needed. They do whenever they have capacity. We’re hoping it’s something that can be put in place so PCP can reach out to mental healthcare providers in real time when they have a patient who might have mental health problems.”
Still, the pandemic did underscore the importance of mental healthcare, both to patients and providers. This is helping lower stigma about seeking mental healthcare.
“There was an enormous surge in mental health issues during the pandemic which brought more attention to these issues,” said Rich O’Neill, PhD, a fellow of the Academy of Clinical Psychology, psychologist and professor at Upstate Medical University. “The awareness of mental health issues in general has been building prior to the pandemic for many years. PCPs are more aware of it and there’s more attention to it in medical school.”
Upstate Medical University began a new initiative, Nappi Wellness Institute, a 200,000 square-foot outpatient facility that includes primary care and specialty healthcare, including social services and behavioral health. By addressing mental health as part of wellbeing and physical health, providers can better ensure that patients receive the care they need.