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Bridging the Gap between Primary Care and Mental Health Professionals

The mental health needs of patients often go unmet.

Recently I had a conversation with a woman who is a chronic migraineur, and it got me thinking about the profound gap separating primary care physicians from mental health professionals. This woman's migraines were so severe that she would have to miss several days of work. When she went to see her primary care physician about it, he prescribed two medications for the migraines. In addition, he encouraged the patient to eliminate the cause of her­ stress. And there it stopped. He sent her on her way.

It became clear to me in the course of my conversation with her that she was suffering not only from the migraine pain, but also from severe workplace stress, job-related anxiety, and other feelings such as guilt, helplessness, and anger. In other words, there was a mental health component to her migraines, which her primary care physician barely acknowledged and did not address.

Because of the huge demands on the time of most nonpsychiatric physicians, coupled with the lack of depth they often bring to treating psychiatric illnesses, the mental health needs of patients they see often go unmet.

I would propose an alternative system for handling the many mental health problems that primary care physicians advise and treat. That would be a system in which mental health referrals would be routine – or even a standard of care – for a suspected psychological problem or when psychotropic medications are prescribed. This approach would improve the quality of care for mental health problems.

Often, emotional problems are a result of physical pain from problems such as headache and backache. That also is the case when it comes to gastrointestinal, cardiac, and skin problems. «In US rendition kill from here untilj “in medicine”; ks»As I wrote over my years as author of "The Psychiatrist's Toolbox" column, in medicine, we know that the sympathetic and parasympathetic innervations control GI disorders (see "Unraveling the Mind/Gut Puzzle"); cardiovascular problems (see "The Mind and Medicine,"); and skin disorders ("Dermatology and The Psyche"). Translation: Many common physical conditions are related to mental health issues.

Perhaps our health care system would do a better job of meeting patients' needs if primary care physicians referred to us and our colleagues in mental health more often. Just as primary care physicians routinely recommend certain labs, EKGs, radiographic studies, or stress tests, they must make it routine to refer whenever they recognize an anxiety- or stress-related problem – including depression.

Moving forward, one approach toward our larger goal might be to have primary care physicians hold a mental health day once a week or perhaps biweekly in their offices or clinics. On those days, patients with mental health problems could see a mental health expert – whether a psychiatrist, psychologist, psychiatric nurse practitioner, or mental health social worker. The point would be to have the mental health problem, whether one of the anxiety disorders, stress-related issues, depression, or the myriad of psychiatric disorders that are first seen by primary care physicians, addressed by those experts trained to do this kind of intervention and care, as part of the general health care routine. In these sessions, a strategy would be put into place – whether short-term interventions, a cognitive-behavioral program, or a more dynamic approach.

Psychiatric and psychological associations need to be more in the forefront of these kinds of changes. To date, we see more awareness about mental health problems from big pharma (not that there's anything wrong with that) for commercial reasons than from mental health organizations. This needs to change.

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This blog aims to present psychiatric/psychological information to a general readership, offering insights into a variety of emotional disorders, as well as social issues that affect our emotional well-being. It includes the ideas and opinions of Dr. London and other leading experts. This blog does not provide psychotherapy or personal advice, which should only be done by a mental health care professional during a personal evaluation.

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