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Monday Jun 03, 2019

Rural FPs Need More Support in Treating Mental Illness

As family physicians, we all see how our practices and patients are burdened by the mental health issues we encounter. We are the front line for mental health care in our communities, but too often we are held back by payers and the rest of the health care system.

[female physician talking with female patient]

The CDC estimates that upward of 50% of Americans(www.cdc.gov) will experience some form of mental illness or disorder in their lifetime, and the National Institute of Mental Health estimates that one in five adults has a mental illness(www.nimh.nih.gov) in any given year. Reports indicate that anxiety and generalized anxiety disorder, specifically,(www.nimh.nih.gov) are increasingly prevalent in the United States. Although there is more than one possible explanation -- whether an actual increase in the incidence of new diagnosable anxiety or simply that people are more willing to discuss their mental health issues -- many family physicians would tell you they are seeing an ever-rising number of patients in their offices with mental health problems.

Mental health issues know no social, economic, racial or geographic boundaries, but for rural America, there is a well-documented gap when it comes to mental health care.(www.cdc.gov) Rural areas are disproportionately poorer than other areas of the country, and patients here face many more barriers to addressing mental health issues than their urban counterparts, disparities that have created what many consider to be a crisis.(www.desmoinesregister.com)  

For example, AAFP policy advises family physicians to take a multidisciplinary approach to mental health care by working "with behavioral and mental health professionals whenever possible to ensure the best care for their patients." Rural patients, however, face more barriers to obtaining this care because of inadequate access and availability.

The problem isn't just a shortage of multidisciplinary providers in rural areas; payers also play a large role. I've seen this in my own practice. One situation in which many rural patients face significant barriers to accessing care is when they seek counseling for some of the most common mental illnesses, like GAD and depression. My practice recently consulted with one of the two counselors in our area about helping us treat our patients using a multidisciplinary approach -- especially our Medicare patients, who face additional barriers to mental health treatment that are not experienced by patients with commercial insurance. What we found was that the deck was stacked against us. We had a provider who was willing and able to be a part of our team and see our Medicare patients for counseling, but CMS allows only clinical psychologists to bill for counseling services. Unfortunately, the counselors in our area do not have that specific degree, and we were forced to abandon our plan to address this need in our community.

Just as treatment for mental health requires a multidisciplinary approach, our strategies for addressing disparities also need to be multifaceted. When I talk to medical students and residents who rotate through my clinic, I always advise them to seek out any training they can on mental health care, whether that means psychiatric rotations or training in cognitive behavioral therapy.

This is not a problem that will be fixed easily or quickly, but we family doctors must continue to advocate in our communities, our states and in Washington, D.C., for changes that will move us toward better mental health care.

Tate Hinkle, M.D., is a family physician in Alexander City, Ala. You can follow him on Twitter @bthinkle.(twitter.com)

Read other Fresh Perspectives posts by this blogger.

Posted at 12:25PM Jun 03, 2019 by Tate Hinkle, M.D.

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