Doctors who do not specialize in mental health may not give it much thought. After all, if a patient comes to you seeking treatment for diabetes or cataracts, whether or not they suffer from depression or alcoholism is beyond the scope of the visit, right? Wrong.
While behavioral health care has long “languished on the backburner,” this began to change last year “as the industry’s stakeholders — from employers to insurers — recognize[d] mental health as important to their employees’ and customers’ well being and productivity,” stated PwC’s Health Research Institute’s annual report, “Top health industry issues of 2016.”
Doctors of all specialties will also need to address behavioral health going forward. Currently, one out of five adults in the U.S. experiences a mental illness every year. About a third of those who have medical conditions also have mental health disorders, according to 2011 research by the Robert Wood Johnson Foundation. And perhaps more eye-opening, 68 percent of adults with mental illnesses also have medical conditions. Let’s take a look at how this issue is impacting doctors.
A costly problem
Medical Economics has called behavioral health—which includes both mental illness and substance abuse—“the new frontier in primary care.” Patients with behavioral health problems cost two to three times as much to care for as those without them, reports the magazine. Mental health conditions cost U.S. businesses more than $440 billion annually, according to PwC. A major reason is that these patients often don’t take care of themselves, often due to lack of diagnosis or resources.
As health care continues to shift from fee-for-service to value-based care, integrating mental health into all areas of medicine is becoming more common. After all, inquiring about patients’ behavioral health is integral to getting a clear picture of their overall health. Asking about substance abuse, whether they own a gun, etc. “is going to become part of the standard of medical care,” ob/gyn Michael Caudle, M.D., told Medical Economics.
“You’re not going to be able to avoid asking these questions in practice, or you’re not going to have proper reimbursement. And when you find answers to those questions, you’ll need some way to deal with it,” Dr. Caudle said.
Barriers to care
So what’s stopping patients from seeking help for behavioral health issues? It’s a combination of factors that comprises access, trust, and cost.
One problem is patients’ lack of access to proper care. “More than half of U.S. counties — all rural — have no practicing mental health clinicians,” found the PwC report. Because of this, it often falls to other types of doctors to address mental health issues with their patients. In fact, primary care physicians provide most mental health care, reports Medical Economics.
It’s also true that patients are most likely to discuss mental health with their primary care doctor because they already have an established relationship and a level of trust that has built up over years of interactions, points out the American Academy of Family Physicians (AAFP).
“That relationship makes it easier for family physicians to get an honest answer when they ask patients, ‘How are things at home?’ or ‘Do you feel safe?’” reports the AAFP. Patients who would never seek out a therapist or a psychiatrist may trust a doctor they see regularly with their mental health problems.
Fair or not, many patients feel there’s a stigma in seeking help for behavioral health issues. “We are working to build a culture in which it is as appropriate to mention that you are struggling with depression as it is to say you are struggling with diabetes,” said Ken Dolan-Del Vecchio, a vice president in Prudential Financial’s health and wellness organization, in the PwC report.
Lastly, “low insurance reimbursement means patients often can’t afford mental health care, and some health plans make it difficult for doctors to refer patients,” according to Medical Economics.
What can doctors do?
So what’s stopping doctors from better addressing patients’ behavioral health needs? The answer is also a combination of factors, which includes referrals and reimbursement.
While some larger health systems are integrating behavioral health into primary care using on-site providers and tools such as videoconferencing, reports PwC, few doctors in private practice are doing so, “due largely to the lack of financial support for it in the fee-for-service world,” writes Medical Economics. “But that situation is likely to change.”
The first step in determining whether or not you should integrate behavioral health into your practice is “to honestly assess your needs by reviewing patient records for diagnoses, consulting all staff to identify patients by types of behavioral needs, and then to determine if there is a need that is not being met in your practice,” explains an article in Physicians Practice, which outlines three options for practices that wish to address mental health.
While you may ultimately decide that partnering with or providing office space to a behavioral health professional is the right move for your practice, the AAFP states that the large majority of behavioral and psychosocial issues can be addressed by family physicians. The key is knowing when to refer if the problem goes beyond your expertise as a doctor, just like with any other health issue. While there are still many unknowns and obstacles, mental health integration will be a critical part of improving health care delivery in the future.