FPs Are Integral to Diagnosis, Treatment of Mental Illness
By Leslie Champlin
• AAFP Assembly San Francisco
9/30/2005
A young adult has persistent stomachaches. Think mental health. A child presents with chronic headaches. Think mental health. An elderly man complains of fatigue. Think mental health. A diabetic fails to take insulin. Think mental health.
"There are families who have children with mental disorders, and they're not getting care because we live in a society where having the diagnosis of a mental disorder is worse than having the illness," family physician and former U.S. Surgeon General David Satcher, M.D., Ph.D., tells hundreds of Assembly attendees.
These and millions of other Americans are battling two conditions: the presenting complaint and the psychological underpinnings that either trigger or derive from the physical problem. These are precisely the mental health patients family physicians should treat because -- for many -- FPs are their first contact with the health care system, said FP David Satcher, M.D., Ph.D., interim president of Morehouse School of Medicine, Atlanta, and former U.S. surgeon general, during his Assembly lecture Sept. 29, "Mental Health in Primary Care."
"There is a continuum between mental health and mental illness," said Satcher. A decline in one can spur or contribute to a decline in the other. Moreover, mental disorders can strike at any age, in response to any life situation or diagnosis of another illness, he said. "None of us can take our mental health for granted. You can be healthy today and go through the trauma of a 9/11" and develop problems.
Prevalence of Mental Illness
One in five Americans has a diagnosable mental disorder each year; one in 10 children and adolescents has mental illness severe enough to cause impairment. Despite that, stigma prevents more than half of affected adults and two-thirds of affected children from getting help, said Satcher.
The results: 81 to 85 Americans commit suicide each day; jails house growing numbers of untreated mentally ill inmates; patients' chronic conditions escalate to emergencies because they fail to follow treatment plans.
"Depression in chronic disease is very high," Satcher told the audience. "If you want to control diabetes in a patient and that patient has clinical depression that you don't deal with, how successful are you going to be in treating his chronic disease?"
The results: 81 to 85 Americans commit suicide each day; jails house growing numbers of untreated mentally ill inmates; patients' chronic conditions escalate to emergencies because they fail to follow treatment plans.
"Depression in chronic disease is very high," Satcher told the audience. "If you want to control diabetes in a patient and that patient has clinical depression that you don't deal with, how successful are you going to be in treating his chronic disease?"
On the Front Line
Family physicians' expertise puts them on the front line for diagnosing and treating mental disorders, according to Satcher.
"The only way we're going to get an early diagnosis and treatment is because primary care providers are attuned to mental disorders in their practices," he said.
To that end, family physicians should, for example, watch for symptoms of post-traumatic stress disorder among patients who have experienced -- even through television -- the traumas of Sept. 11 and hurricanes Katrina and Rita. FPs should look for signs of depression among chronically ill patients and their caregivers.
"Mental disorders have to be looked at through the lifespan," Satcher said. "It's up to us to close the gap between what we know and what we do."
"The only way we're going to get an early diagnosis and treatment is because primary care providers are attuned to mental disorders in their practices," he said.
To that end, family physicians should, for example, watch for symptoms of post-traumatic stress disorder among patients who have experienced -- even through television -- the traumas of Sept. 11 and hurricanes Katrina and Rita. FPs should look for signs of depression among chronically ill patients and their caregivers.
"Mental disorders have to be looked at through the lifespan," Satcher said. "It's up to us to close the gap between what we know and what we do."
