Effective treatment requires coordinating primary, behavioral health care
When I began my career as a family physician, I never expected that one-third of my patient visits on any given day would be spent addressing mental health concerns. But that is the reality at my rural practice in Deltaville, Virginia, where I’ve worked for more than 25 years.
Nor is my experience unique. Every day, primary care physicians across the country provide mental health care. In many cases, family physicians are providing care for patients who otherwise might not have access to it. But there are barriers that need to be addressed for us to tackle our patients’ complex mental health needs effectively and comprehensively.
Recent data show what family physicians on the front lines of health care already know: the mental health crisis in the U.S. is growing. Sobering new CDC data reveal a 4% rise in suicides from 2020-2021, the largest single-year increase in the last two decades. In fact, suicide is the second leading cause of death for people aged 10-34.
Family physicians are often the first point of contact for people seeking mental health care. About 40% of all visits for depression or anxiety in the U.S. take place in primary care offices, where 50% of all medications prescribed for mental health disorders are written.
Those numbers tell an important story: family physicians have trusted relationships with our patients and their families and our communities—often forged over years or even decades. We also know how to screen for conditions like anxiety and depression and prescribe medication when appropriate, and we know how to work with our colleagues and refer a patient to a specialist when needed. Because of these strong ties and our expertise, it’s easier for a patient to talk to their family doctor about their mental health and for us to recommend a course of treatment that works best for them.
There is no doubt in my mind that without family physicians, many of the nearly one in five U.S. adults who experience some form of mental illness each year would go untreated. To make real progress in addressing the mental health crisis, we must focus on a proven solution: integrating behavioral health and primary care.
This will increase patients’ access to mental health care by consistently coordinating referrals or making behavioral health services available right inside the primary care clinic. In my opinion, a patient is much more likely to follow up with a mental health clinician if that person is located in an office they’re already familiar with or if scheduling can be done easily through their primary care physician.
However, challenges remain. Among them are a limited mental health care workforce, steep start-up costs and reporting requirements. The American Academy of Family Physicians, the organization for which I serve as board chair, advocates for policies and investment that will bolster access to mental health services, including in the primary care setting. This includes increased state, federal and private insurance funding for mental health care services, as well as adequate payment systems to ensure primary care physicians and the mental health clinicians they work with are appropriately reimbursed for the mental health care we consistently provide.
The startling increase in suicide rates and uptick in depression, anxiety and other mental conditions in the U.S. is cause for concern. But I want my patients and community to know this: Family physicians are an integral part of the solution to the mental health crisis we see today. We know our patients, we know how to help, and we stand ready to work with policymakers and public health officials to ensure everyone can access needed mental health services.
Sterling N. Ransone Jr., MD, FAAFP, is a family physician in Deltaville, Virginia, and board chair of the American Academy of Family Physicians.