Managing Behavioral Health Issues in Primary Care: Six Five-Minute Tools
These practical strategies can help family physicians support patients with depression, anxiety, and other behavioral health issues.
Fam Pract Manag. 2017 Mar-Apr;24(2):30-35.
Author disclosure: no relevant financial affiliations disclosed.
Consider this: About three-quarters of the patients on your schedule today likely have a clinical problem with a significant psychological or behavioral component.1 Most patients with psychological issues seek help from you, their primary care physician, not from a specialty mental health provider.2,3 Furthermore, caring for patients' emotional well-being plays an important part in preventing, diagnosing, and treating the top 15 causes of death in the United States.4
One of the most commonly used treatment approaches for psychosocial problems and emotional distress is psychiatric medication. Although practice guidelines support the use of antidepressants for severe depression in adults, greater controversy exists about their effectiveness, acceptability, potential risks, and safety in other groups (e.g., children or patients with mild or moderate depression). Further, some patients do not want medications for a variety of reasons such as stigma, cost, side effects, and drug interactions. As a result, family physicians often need additional tools for addressing patients' behavioral health needs.
In many practices, embedded behavioral health providers work alongside family physicians, helping patients with a broad range of issues including depression and anxiety, medication adherence, chronic pain, smoking cessation, weight loss, and chronic illness management. Although these integrated models are growing, it's imperative for family physicians to have a toolbox of skills for managing behavioral health issues independently, for several reasons. First, even in fully integrated clinics, behaviorists are not always available; limited funding may preclude sufficient staffing of positions, and behaviorists often have multiple demands on their time. Second, some patients are not willing to see a behavioral health provider, often due to the stigma surrounding mental illness. Third, family physicians who work in rural areas may lack adequate behavioral health referral sources or encounter the challenges associated with dual relationships in small towns. Finally, some insurance plans don't cover behavioral health services or have high deductibles and out-of-pocket costs for these services, making psychotherapy practically inaccessible.
This article shares six specific tools primary care physicians can use to help them care for patients with behavioral health care needs.
Six five-minute tools
Working with patients in severe emotional distress can be exhausting and overwhelming. Physicians may feel a responsibility to “fix” their patients' pain, but of course there are no quick solutions for life stressors and mental illness. Introducing one of the following behavioral health tools may seem like
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1. Robinson PJ, Reiter JT. Behavioral Consultation and Primary Care: A Guide to Integrating Services. New York: Springer;2007....
2. Olfson M, Kroenke K, Wang S, Blanco C. Trends in office-based mental health care provided by psychiatrists and primary care physicians. J Clin Psychiatry. 2014;75(3):247–253.
3. Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. Twelve-month service use of mental health services in the United States: results from the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62(6):629–640.
4. Center for Disease Control. Deaths, percent of total deaths, and death rates for the 15 leading causes of death, United States and each state, 2014. https://www.cdc.gov/nchs/data/dvs/lcwk9_2014.pdf. Accessed Feb. 1, 2017.
5. Richards DA, Ekers D, McMillan D, et al. Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet. 2016;388(10047):871–880.
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