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Wednesday Sep 28, 2016

Mental Health Resources Lacking in Opioid Crisis Fight

I spent last week surrounded by my colleagues at the Family Medicine Experience (FMX) in Orlando, Fla. Besides the requisite pilgrimage with my family to the House of the Mouse, there also was plenty of time for CME and educational sessions. I heard amazing speakers, and several of our AAFP leaders encouraged us to "Never stop learning." 

In the days before FMX, the Congress of Delegates -- the Academy's policy-making body -- voted on resolutions that will impact all of us. Many of the resolutions that made their way through the Congress dealt with issues related to payment reform or medical education. There were several resolutions about creating educational programming and research projects.

But one topic that came up again and again in comments from AAFP leaders and officer candidates (nearly everyone who stepped foot on the dais) was the ongoing opioid and drug abuse crisis in the United States. Many speakers supported changes in prescribing practices and better access to rehabilitation services. Delegates also questioned the value of using pain as a vital sign. Several physicians shared stories of caring for patients who were fighting -- or not fighting -- addiction. 

And one overwhelming sentiment kept rising to the top of each conversation. This isn't just a drug problem -- or a prescribing problem -- that we're facing. It's not just a chronic pain problem. It is, in large part, a self-medication and mental health problem. Too many people are trying to treat their physical and mental maladies with a quick fix. It's a problem that requires health care teams to address multiple factors, find the root causes(painmedicine.oxfordjournals.org) and educate patients while addressing their physical needs.

Unfortunately, our culture -- and, therefore, our health care system -- has devalued mental health to the point that hospitals can no longer afford to maintain adequate staffing and facilities for the care of those with mental illness. Every week I hear about another hospital shuttering a behavioral health unit. In 1955, there were 340 public psychiatric beds available per 100,000 people. In 2005, there were 17 beds per 100,000 people(www.treatmentadvocacycenter.org). There just aren't enough mental health resources for the people who need them most. Psychologists, psychiatrists and the remaining mental health facilities continue to expand existing resources, but training time limits the buildup of infrastructure. Appointment slots are limited, and facilities may also be far from the patients they serve or may require certain insurance or monetary payments up front. Some patients, consequently, feel they have few options aside from waiting(www.wbur.org).

So how do you and I figure into that framework? As family physicians, we can serve as a first point of contact for patients unable to obtain mental health services. Although my training in mental health has been limited, probably much like that of many other family doctors, I've worked hard to learn as much as I can about behavioral science and the use of both medications and behavioral therapies in the treatment of mental illness.

The AAFP has exhaustive policy and resources on this issue, as do others. But being prepared is just the beginning. 

We should also be aware of the available drug and addiction treatment programs, and work to develop partnerships with community resources. We, as family physicians, can collate the services in our areas and begin to form partnerships for better care coordination. 

The Comprehensive Primary Care initiative (now Comprehensive Primary Care Plus) even supplies a framework for integrating psychological services into the primary care office with an eventual goal of integrating on-site mental health providers. In the meantime, knowing where and with whom patients will be working allows us to coordinate care more efficiently. For areas completely devoid of mental health services or for patients unable to travel, telemedicine services with mental health professionals are expanding rapidly(www.forbes.com).

No single mechanism or pathway will work for every patient, but our training as family physicians makes us well-suited for care coordination and holistic care.

Gerry Tolbert, M.D., is a board-certified family physician who practices in northern Kentucky. A lifelong technophile, his interests include the intersection of medicine and technology. You can follow him on Twitter @DrTolbert(twitter.com).

Posted at 02:58PM Sep 28, 2016 by Gerry Tolbert, M.D.

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