The treatment of patients with mental health conditions illustrates the best of family medicine and, too often, the worst of the US health care system. Family physicians are well-positioned to diagnose and manage these conditions.1 Patients trust us with difficult situations and uncomfortable, confusing symptoms. We already address their preventive health needs or care for their chronic medical conditions, so it is natural that we also would provide care for their depression symptoms or new-onset panic disorder. So many physical health conditions are accompanied by mental health conditions that management of both in primary care is a reasonable approach.
At the same time, mental health care is best managed by a team. The US health care system approaches mental health care as a carve-out service. Rather than being seen as a single person needing coordinated, seamless care, sometimes a patient is treated under one set of conditions or coverage for physical health and a completely separate set of conditions or coverage for mental health. A health care system renowned for its cancer and orthopedic care may not provide mental health care at all, or may provide only psychiatric care.
The models of mental health care with the best evidence of success include fully integrated mental health and primary care, in which mental health clinicians collaborate with primary care clinicians to support one another’s care of the patient. In these collaborative care models, a patient is seen as one person who needs care from multiple members of an expert team. This increases the likelihood of a good outcome for the patient and can reduce the stigma a patient may feel when undergoing an evaluation or experiencing a symptom, particularly if the patient has a history of traumatic experiences.
Unfortunately, most of us work in a fragmented environment where we refer patients to a mental health clinician, such as a social worker, psychologist, or other licensed therapist, for comanagement. Communication is hindered by incompatible health records and the need for privacy.
This edition of FP Essentials hopefully will strengthen your ability to care for patients with mental health conditions, even if you do not yet work in a fully collaborative care model. Section One covers the diagnosis and management of major depressive disorder. Section Two addresses bipolar disorder, and Section Three details information about suicide and suicidality. Finally, Section Four discusses generalized anxiety and panic disorders. Each section covers screening, diagnosis, and management of these common conditions.
Family physicians and primary care clinicians will care for many patients with mental health conditions. Compassion, knowledge, and an effective team will help support our work in this area. I hope you find this edition of FP Essentials useful in your practice.
Kate Rowland, MD, FAAFP, Associate Medical Editor
Vice Chair of Education and Associate Professor,
Department of Family Medicine
Rush University, Chicago, Illinois