February 26, 2024

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

In 1954, Dr. Brock Chisholm, the first director general of the World Health Organization: “There is no health without mental health.” While we have certainly made great strides in behavioral health care in the seventy years since Dr. Chisholm’s statement, it often seems as if we have not yet taken his words to heart. Mental health and physical health remain clearly separated, with little limited interaction between those who treat the mind and those who treat the body.

This fragmented approach has a negative effect on the patient’s well-being. People with chronic diseases are more likely to develop 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 experience anxiety or depression, yet only a quarter of diabetic patients with depression are ever diagnosed or treated for their mental health problems.

Research also shows that people with mental health conditions are less likely to seek medical help. There is a need for closer coordination of primary care and mental health care within our healthcare system.

That alignment starts with how we educate medical and behavioral health students. There is a strong need for more interprofessional education and practice (IPE).

Our current approach has allowed fear around mental health stigma to continue to flourish. One study found that three-quarters of people with mental illness feel that stigma has not improved in the past decade.

About 80 percent reported that their fear of being stigmatized or discriminated against kept them from living a good life, including seeking help for their mental health. Patients fear that if they disclose their mental health problems to doctors, their symptoms will not be taken seriously when they seek care for non-mental health problems.

Unfortunately, those fears are not unfounded. People with a history of mental illness report receiving poorer care for their physical health problems, thanks in large part to a phenomenon known as diagnostic overshadowing, in which medical professionals incorrectly attribute physical symptoms to a patient’s mental illness.

In addition to combating stigma, improving the integration of behavioral health and primary care can also help significantly increase access to mental health care. As a recent report from the Brookings Institution shows, 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 spread across the country. At the urging of the U.S. Preventive Services Task Force (USPSTF), a growing number of primary care physicians have begun screening for depression and anxiety using a simple questionnaire.

“There are a lot of patients who come to primary care who may be experiencing symptoms but don’t bring them up,” Michael Silverstein, vice chair of the task force, told the Washington Post. “So it’s about finding people and easing that burden sooner, rather than waiting for them to come to their doctor with signs or symptoms.”

Screening is a crucial 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 general health care services in hospitals, recently announced that it will be rolling out tools to deliver 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 brings together mental health and primary care practitioners within the same office, removing a significant barrier to finding behavioral health care. If a doctor identifies a patient 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 spiritual counselors at master’s and doctoral levels. It helps close gaps in care while training the next generation of behavioral health professionals to view 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, helping them graduate as well-rounded health professionals with a keen understanding of how to approach behavioral and physical health together.

Our students who have chosen our Integrated Healthcare concentration have the opportunity to take courses on the theoretical and research aspects of integrated healthcare and then receive hands-on training at their practicum and remote locations where they can apply the theoretical constructs.

One of the most unique features of our students’ education is a health sciences course, where they learn the core 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 healthcare professionals approach treating patients and how behavioral health and physical health can be integrated to provide a more comprehensive and, in many cases, more cost-effective approach to the provide treatment to patients. Most importantly, they lead to a better clinical outcome for patients.

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

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

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

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