September 21

Now More Than Ever, Family Medicine Needs To Focus On Mental Health

Now that the stress of the pandemic tends to exacerbate patients' health issues, primary care physicians face an unprecedented opportunity to take care of both their physical and mental health issues.

It is not a surprise that the COVID-19 pandemic caused damage to mental health in the U.S. as it brought isolation, economic instability, and life uncertainty. In October 2020, the International Committee of the Red Cross established that more than 50% of adults feel that COVID-19 has a negative effect on their mental health. The committee has described the psychological distress caused by the pandemic a "crisis within a crisis."

WHY FAMILY MEDICINE SHOULD FOCUS ON MENTAL HEALTH

There are three main reasons you should include mental health care into your practice.

Your patients need you.

Being a family physician, you are in the best place to address mental health issues. Research shows that 80% of people with a behavioral health disorder will visit a primary care physician at least once a year. Besides, some patients would prefer seeking help from their family physician rather than a specialty mental health provider. At least a quarter and possibly much more of the work of family physicians is associated with psychological issues. At a time when medical care is becoming increasingly influenced by technology, including clinical examinations by video, increasing reliance on laboratory tests, reliance on the information available on the internet rather than personally acquired knowledge, carefully listening to patients still has a lot to offer. It has been proven that, in addition to medications, brief psychotherapy for depression can be provided effectively in primary care. Of course, there are cases when family physicians should make a referral to a behavioral health specialist. Still, up to 50% of patients referred to a mental health specialist will not make their first appointment.

You will do better as a doctor.

You might be surprised, but after treating your patients' psychological illnesses, their physical health improves as well. Patients with mental health issues have a more significant risk of developing diabetes, cardiovascular disease, obesity, high pressure, and other conditions. Moreover, patients with depression tend to have less physical activity, a less healthy diet, and higher alcohol consumption. Dealing with psychological problems beforehand will help avoid these consequences.

You will save the system money.

There is evidence that psychotherapeutic attention to patients' personality and relationship difficulties can be cost-effective in the long term, with reduced visits to family physicians and emergency departments and reduced use of inpatient beds. One of the most expensive conditions for the health system is depression. When treated earlier on, it will result in saving tons of money.

HOW FAMILY PHYSICIANS CAN ADDRESS MENTAL HEALTH

Here are four ideas for incorporating mental health care into your practice.

Use online services to expand access to mental health care.

During the COVID-19 pandemic, CMS has changed regulations for telemedicine services for Medicare beneficiaries, giving permission to provide audio-only telehealth visits.

Check both mental and physical health.

Since 2016, the U.S. Preventive Services Task Force has recommended a few different questionnaires designed for screening for depression in the general adult population. Moreover, the Lancet Psychiatry Commission has recommended screening for physical health among patients with mental conditions. With the increasing number of patients suffering from mental illnesses, it is essential for us to prevent their physical health from being neglected. Among other measures, we should concentrate on thorough screenings on exercise, diet, obesity, substance abuse, sleep, and cancer.

Pursue behavioral health integration.

Integration of psychoanalytic principles in the management of patients can simultaneously reduce costs and improve clinical outcomes and treatment outcomes in the management of both mental illness and chronic physical condition. Consideration of the patient's personality and the recognition of the patient's having personality disturbance and interpersonal difficulties, in addition to depressive symptoms, is essential in managing patients with any condition.

Improve your education.

Family physicians generally are not trained to perform psychoanalytic psychotherapy. Formal training in psychoanalysis or psychoanalytic psychotherapy is undertaken by a minority of mental health professionals. However, with increasing awareness of the limitations of antidepressant medications and short-term, symptom-focused psychotherapies, there is some increased awareness of the value of psychoanalytic psychotherapy and psychoanalysis. With adequate training, you will feel more confident in applying psychotherapeutic techniques into your practice.

What makes primary care challenging but also rewarding is the unique privilege of providing comprehensive, holistic care. Especially now, with many patients' health care issues aggravated by the stress of the pandemic, we have a rare opportunity to address both their physical and mental health needs.

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