Mind and body: We cannot treat primary care and mental health as separate systems

Mind and body: We cannot treat primary care and mental health as separate systems

In 1954, Dr. Brock Chisholm, the first director-general of the World Health Organization, declared: “There is no health without mental health.” While we have certainly made great strides in behavioral care in the seven decades since Dr. Chisholm, it often seems as if we still haven’t taken his words to heart. Mental health and physical health remain distinctly isolated, with little interaction limited between those who treat the mind and those who treat the body.

This fragmented approach is negatively impacting patient well-being. Indeed, people with chronic diseases are more likely to experience depression, while people with depression are also more likely to develop chronic diseases. For example, we know that people with diabetes are up to three times more likely to have anxiety or depression, and yet only a quarter of diabetic patients with depression are ever diagnosed or receive treatment for their mental health conditions.

Research also shows that people with mental health problems are less likely to seek medical care. There is a need to more closely align primary care and mental health services within our health care system.

This alignment begins with how we train medical and behavioral health students. There is a great need for more interprofessional education and practice (IPE).

Our current approach has helped the fear surrounding mental health stigma continue to thrive. A study found that three-quarters of people with mental illness feel as though the stigma has not improved over the past decade.

About 80 percent reported that their fear of being stigmatized or discriminated against prevented them from living their best lives, including seeking help for their mental health. Patients are concerned that if they tell doctors about their mental health concerns, their symptoms will not be taken seriously when they seek care for mental health concerns.

Unfortunately, these fears are not unfounded. People with histories of mental illness report receiving worse care for their physical health problems, largely thanks to a phenomenon known as diagnostic shadowing, in which medical professionals mistakenly attribute physical symptoms to the patient’s mental illness.

Beyond combating stigma, improving the integration of behavioral care and primary care can also help greatly expand access to mental health services. As a recent report from the Brookings Institution notes, specialty behavioral health providers remain uncommon in low-income neighborhoods, communities of color, and rural areas in the United States.

Conversely, there are approximately 230,000 primary care practices in locations across the country. At the urging of the US Preventive Services Task Force (USPSTF), a growing number of primary care physicians have begun screening for depression and anxiety through the use of a simple questionnaire.

“There are many patients who come to primary care who may have symptoms but do not present,” Michael Silverstein, vice chair of the task force, told the Washington Post. “So it’s about finding people and relieving that burden earlier, rather than waiting for them to come to their doctors with signs or symptoms.”

The review represents a critical first step, but other efforts are now going even further. This month, a bipartisan group of lawmakers introduced legislation to improve mental health care for seniors on Medicare by integrating behavioral health services into their primary care. Community Health Systems, the largest provider of hospital-based general health care services, recently announced that it was opening tools to offer virtual mental health services to its 700 affiliated primary care providers.

M Health Fairview, a partnership between the University of Minnesota and Fairview Health Services, now co-locates mental health and primary care practitioners within the same office, removing a significant barrier to finding behavioral care. If a doctor identifies a patient who is struggling with their mental health, they can simply walk the patient down the hall and introduce them to their colleague. In this case, those colleagues are master’s and doctoral level mental health physicians. It’s helping fill gaps in care while training the next generation of behavioral health experts to think about the connection between mental health and primary care as second nature.

At the John F. Kennedy School of Psychology and Social Sciences, where I serve as dean, students receive experiential training in primary care settings, ensuring that they graduate as bona fide health professionals with a keen understanding of how health should be treated. of behavior and physics. in the same time.

Our students who chose our Integrated Health Care concentration have the opportunity to take courses in the theoretical and research aspects of integrated health care and then they receive practical training at their internship and externship sites where they are able to apply the theoretical constructs .

One of the most unique features of our students’ training is a course in the health sciences where they are taught the essential principles of interprofessional education and practice with nursing, physical therapy, physician assistant, podiatry, and social work students. This allows them to gain a greater appreciation of how other health care professionals approach the treatment of patients and how behavioral health and physical health can be integrated to provide a more comprehensive approach and, in many cases, a more cost-effective approach to treating patients and most importantly, lead to a better clinical outcome for patients.

Colleges can help improve this connection by offering students practicums, internship opportunities, and program concentrations that integrate these two closely related disciplines.

Better integration of behavioral and physical health care can help improve patient outcomes, reduce health care costs, and dismantle the widespread stigma surrounding mental health. And slowly but surely, our healthcare education system is finding ways to ensure that mental health is treated as the necessary component of human health that it really is.

Alvin McLean, PhD, is dean of the JFK School of Psychology and Social Sciences at National University.

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