Mind and body: We can’t treat primary care and mental health as disconnected systems


In 1954, Dr. Brock Chisholm, the first director-general of the World Health Organization, said: “There is no health without mental health.” While we have certainly made great strides in behavioral care in the seven decades since Dr. Chisholm's statement, it often seems like we have yet to take his words to heart. Mental health and physical health remain clearly compartmentalized, with little limited interaction between those who care for the mind and those who care for the body.

This fragmented approach harms patient well-being. Indeed, people with chronic illnesses are more likely suffer from depression, while people with depression are also more likely to develop chronic illnesses. For example, we know that people with diabetes are up to three times more likely suffer from anxiety or depression, yet only a quarter of diabetic patients with depression are diagnosed or receive treatment for their mental health problems.

Research also shows that people with mental health problems are less likely to seek medical care. There is a need to more closely align primary care and mental health services within our health system.

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

Our current approach has contributed to growing fears of mental health stigma. A study found that three-quarters of people People with mental illness feel like stigma has not improved over the past decade.

About 80 percent said their fear of being stigmatized or discriminated against prevented them from living their best lives, including seeking help for their mental health. The patients are worried 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, these fears are not unfounded. People with a history of mental illness report receiving poorer care for their physical health problems, largely due to a phenomenon known as diagnostic eclipsein which medical professionals incorrectly attribute physical symptoms to a patient's mental illness.

Beyond addressing stigma, improving the integration of behavioral and primary care can also help significantly expand access to mental health services. As a recent report According to notes from the Brookings Institution, specialized behavioral health providers remain scarce in low-income neighborhoods, communities of color, and rural areas across the United States.

Conversely, there are approximately 230,000 primary care practices located throughout the country. At the request of the U.S. Preventive Services Task Force (USPSTF), a growing number of primary care physicians have begun screening for depression and anxiety with a simple questionnaire.

“Many patients who come to primary care may experience symptoms but don't talk about them,” Michael Silverstein, vice chair of the task force, told the Washington Post. “So it's about finding people and alleviating that burden earlier rather than waiting for them to present to their doctor with signs or symptoms.”

Screening represents a crucial first step, but other efforts now go even further. This month, a bipartisan group of lawmakers introduced legislation improve mental health care for older adults on Medicare by integrating behavioral health services into their primary care. Community Health Systems, the largest provider of general hospital healthcare services, recently announced that it deployment of tools to offer 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, thereby removing a significant barrier to obtaining behavioral care. If a doctor identifies a patient who has mental health issues, they can simply walk them down the hall and introduce them to their colleague. In this case, these colleagues are mental health clinicians with master's and doctorate degrees. It helps close gaps in care while training the next generation of behavioral health experts 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 settings, ensuring that they graduate as seasoned healthcare professionals with a thorough understanding of how behavioral and physical health should be approached. tandem.

Our students who have chosen our integrated health care concentration have the opportunity to take courses on the theoretical and research aspects of integrated health care and then receive hands-on training at their internship and externship sites where they are able to apply theoretical constructions.

One of the most unique features of our students' training is a health sciences course where they learn the fundamentals of interprofessional education and practice with students in nursing, physical therapy, physician assistant, in podiatric medicine and social work. This allows them to better understand 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 treating patients. and more importantly, lead to better clinical outcomes for patients.

Colleges can help improve this connection by providing students with internships, internship opportunities, and program concentrations that integrate these two closely related disciplines.

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

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

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