Heading into the eighth month of the COVID-19 pandemic in the United States, American mental health is in crisis. According to a Kaiser Family Foundation poll the number of adults reporting that the pandemic has negatively impacted their mental health grew from 32% in March to 53% in July. Today, the number is undoubtedly higher.
Vera Whole Health providers anecdotally confirm these statistics. Dr. Paula Dygert says: “I think that most people underestimate how much of primary care is mental health and behavioral health. Most people assume they go to the doctor for cholesterol medicine, diabetes, or an injury. But a lot of people also come to us with chronic pain, headaches, stress, poor sleep, all kinds of issues. Over 50% of my visits have a significant mental health component.”
What is the difference between behavioral health and mental health?
Mental health is a segment of behavioral health that focuses on treating diagnosable conditions related to someone’s mental well-being. Behavioral health includes mental health and the treatment of behaviors arising from a patient’s mental health. For example, overeating might be a behavioral health issue triggered by clinical depression, a mental health condition.
The typical approach to treating mental or behavioral health concerns is to use an outside specialist like a therapist or a counselor. But the stigma attached to therapy keeps many people from getting the help they need to live healthier lives. This reality demands a new approach.
Why the primary care setting is the optimal place to provide behavioral health
As noted above by Dr. Dygert, patients are already coming to their primary care providers (PCPs) with behavioral health issues, even if they do not know it. Because of the pre-established trust with their provider, patients are comfortable sharing their social and emotional concerns.
PCPs have the opportunity to influence the right treatment and ensure their patients get help early, before they have more acute issues. Aligning treatment of behavioral and physical health symptoms together will result in improved health outcomes for the patient overall.
Ideally situated to help, hamstrung by the system
While providers are ideally situated to facilitate behavioral health care, they are hamstrung by the existing healthcare system in three specific ways:
Brief appointment times: Dr. Dygert believes that the 15-minute appointment common in most traditional primary care practices doesn’t provide enough time to properly assess a behavioral or mental health issue.
Inability to schedule appointments on the patient’s behalf: Because of the significant number of no-shows, most mental health professionals will not allow PCPs to schedule appointments on their patient’s behalf. As a result, they can only make recommendations and hope the patient follows through.
Lack of care coordination: Because the majority of behavioral or mental healthcare takes place entirely divorced from the primary care setting, it’s difficult to integrate that care into the patient’s overall care plan.
But the issue remains, the majority of people need help with their mental health. If PCPs are ideally situated to start the conversation about behavioral health, we must equip them with the tools and resources to do so.
Overcoming barriers via advanced primary care with integrated behavioral health
Advanced primary care (APC) models that integrate behavioral health offer an opportunity to provide a better and more effective route to treating mental and behavioral health issues. Let’s take a look at how the model addresses each of the barriers mentioned above.
Brief appointment times
In the APC model, long appointment times are the norm, allowing the PCP adequate time to dig into issues that may present themselves as physical but are actually linked to behavioral health. Dr. Dygert explains:
"It's all about appointment times. First, patients will come in and be like, 'This is happening. My arm is killing me and ...' By the time they've finished talking, 15 minutes have gone by. Our appointment would be done anywhere else. The patient was just getting things off their chest, only then can we really get to what's going on. So the longer appointment time is totally essential to getting the right diagnosis in most cases."
Inability to schedule appointments on the patient’s behalf
An APC model that integrates behavioral health circumvents the typical challenges of scheduling a specialist by keeping a behavioral health professional on staff. This allows the PCP to recommend that, during the course of an appointment, a behavioral health professional be part of the conversation, which builds trust and ensures a stronger likelihood that the patient will follow through and seek out the care they need.
All Vera behavioral health professionals are licensed social workers with some holding advanced degrees in order to ensure a level of expertise. But, it’s important to note here that they do not treat all mental health issues. If necessary, they have a network of qualified providers outside of the care center that they can refer patients to in order to address specific needs.
Lack of care coordination
When behavioral health is provided in the same care center as primary care, it ensures that all levels of the patient’s care are integrated and coordinated. At all times a patient’s confidentiality is respected, and it’s much easier for a PCP to address the patient's follow-through on recommendations, discuss interventions, and partner with the behavioral health professional working with the patient.
Health is about more than just the absence of disease. It’s about ensuring the bio, psycho, and social well-being of a patient are also healthy. American adults desperately need healthcare that supports them in all aspects of their lives right now, and the APC model does just that.