As demand for mental health care continues with its upward trend, many Americans tend to supporters they already trust: doctors. My company does find that nearly one in five people are seeking mental health support from primary care physicians now, and Gallup recently reported that seven in 10 Americans want health providers to ask about their physical and mental health issues. This is a sign of growing awareness of the connection between physical and mental health, and a nervous system. With cost, access and insurance gaps, turning to staff to meet complex emotional needs, it’s time to expand the collaborative model of encountering patients in the patients and connect them with the support they really need.
As a former emergency and urgent care physician, I have witnessed first-hand the challenges of mental health in a medical setting. It is usually quietly a problem as fatigue, pain, stress or sleep. Now, as CEO of the National Mental Health Provider, I see how our system continues to route emotional distress to places that are not designed to be treated.
This is not a burden for primary care. This is an opportunity to strengthen the connection between mental health providers and medical professionals and to create a care model that reflects people’s actual seeking for help.
Limitations of a health care
Primary care doctors are already doing impossible things. On average visits, they are expected to address complex physical problems, preventive care, screening, prescriptions, and more in 20 minutes. In addition to this, stratified mental health support is required, especially for patients who deal with depression, anxiety, trauma, or relationship distress, with very little time and training.
This is not a knock on primary care, but a structural reality. Mental health care requires not only a brief assessment or a one-time prescription. It takes time, clinical depth and continuity; even the most capable PCP thing cannot always be provided in isolation.
The result is that patients do not receive the required support and doctors are managing the conditions that experts should deal with mental health professionals. This creates frustration on both sides of the examination room, and worse, it delays or derails to obtain effective treatments.
Collaborative care is the model – If we invest
One way to bridge the gap between physical and mental health is the Collaborative Care Model (COCM). It sees mental health professionals integrate into the fields of primary care and medical specialists such as kidney disease, heart disease and cancer, so it can be easier to connect these patients with the right support. COCM encourages approaches to similar teams across human health and includes case management to support therapeutic and social issues such as food insecurity, lack of transportation, and clinical support from therapists and drug managers who go hand in hand with doctors and their teams. Starting with a simple recommendation during regular inspections, the result is that people are provided with the help they need before the crisis crisis.
When done well, COCM will improve clinical outcomes, reduce symptoms, and even reduce overall health care costs. Despite the promise, implementation remains inconsistent, often due to a lack of reimbursement, infrastructure or accessible mental health partners.
Mental health professionals do not need to replace primary care, they need to supplement. The goal is not to remove doctors from the equation, but to support them through timely, professional care, thereby reducing their burden and meeting the needs of various patients.
The bet is rising
While more and more people are expressing their willingness to seek mental health support, many are still facing long-term waitlists, affordability challenges and limited availability of providers. This gap reflects both an open cultural shift and a continuing failure of access design.
Without formal behavioral health support, people default to familiarize themselves with: the doctors they trust. That is understandable. But that is why we need to meet this need in a better way, rather than being more stressful to primary care.
The right nursing team can change everything at the right time. But we cannot expect doctors in our country to bear the weight of a parallel mental health system. They have done enough.
As health systems, payers and providers, our collective responsibility for closing this care gap is not through transferring burdens, but through sharing burdens.
This means:
- Expand compensation model for collaborative care
- Invest in digital infrastructure, timely recommendation and coordination
- Prioritize partnerships between primary care and behavioral health providers
- Ensure access to affordable and high-quality mental health care
Primary care physicians are usually the first to hear a patient say, “I’m struggling.” The question is: What happens next?
Let’s make sure the answer is not silence or waitlist. Let’s make sure this is the beginning of true support.
Image source: Aleksei Morozov, Getty Images
Dr. Dan Frogel is CEO of ThriveWorks, a leading provider of in-person and online mental health services nationwide. He began his career as an emergency physician before emergency care. Prior to joining Thriveworks, he was the co-founder of CityMD, one of the largest emergency care providers in the Northeast.
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