The First Step in Getting Mental Health Care

By Ryann Tanap | Jan. 08, 2018

 

When it comes to managing our health, we tend to seek out care from professionals who are trained specialists. Five years ago, I tore a ligament in my ankle and scheduled regular appointments with a physical therapist. Last year, I experienced intense jaw pain and made an emergency appointment with my dentist. And this year, I decided to stop avoiding my mental health and finally made an appointment with a therapist. But I didn’t actually start there.

Like so many others, I decided to begin by talking with my primary care physician (PCP) about my mental health concerns. During my annual physical, I pushed aside the shame and stigma that had been weighing on me for so long, and shared that I wanted to get the help I was certain I desperately needed.

“I think I may have depression,” I mentioned to the nurse during intake. She listened and gave me a form, which I later learned was a screening for symptoms of depression called the PHQ-9 (Patient Health Questionnaire). Later, my PCP reviewed my vitals and the results of the screening, and we discussed my concerns, thoughts and recent behaviors.

“I do think talking to a mental health professional would be helpful,” my PCP advised. She handed me a list of names and contact information, but warned that some might not take my insurance, might have long waiting lists or might not even be taking new patients. I left my appointment with the daunting task of sifting through potential providers, and after a long search, I realized the list was of no help.

After another long search, I eventually found a therapist with availability on my own, through my insurance company’s website.

Should We Seek Mental Health Care from PCPs?

Seeking mental health care from PCPs poses both pros and cons. While primary care providers are not trained mental health specialists, they are frequently on the front lines of initially diagnosing, treating and managing mental health conditions, so they do bring some experience. “Patients often share symptoms or express concerns to their PCP before ever thinking of going to see a psychologist or psychiatrist,” says Claudia*, a nurse who works in an adult primary care office.

This isn’t surprising to me, since I also didn’t think to go straight to a mental health professional. As it turns out, I’m not alone. According to the Centers for Disease Control and Prevention (CDC), one-fifth of all primary care visits address mental health concerns, often resulting in at least one mental health “indicator.” These indicators may include a depression screening, a referral to counseling, a mental health diagnosis or a prescription for a psychiatric medication. This makes sense given that we typically know our PCP and have a relationship with them, and because there’s no stigma attached to seeing a PCP.

Even though our PCPs may be our first instinct—and may feel like a safe choice—several factors often limit the capacity of these health care professionals when working with patients experiencing mental health conditions. These limits include brief appointment times, inadequate reimbursement rates for mental health diagnoses, competing demands of preventative care, confidentiality and disagreements among specialists over what type of care is best for their patients. Now that I’ve been in therapy for several months, I’ve noticed that my PCP and therapist don’t always agree on a treatment plan. I often feel conflicted on whether or not I’m making progress—and to whom I should be going to for mental health care.

Facing the Lack of Access

According to the National Institute of Mental Health, “the primary care provider can treat mental disorders, particularly through medication, but that may not be enough. Historically, it has been difficult for a primary care provider alone to offer effective, high-quality behavioral health care.” Research has found that the most effective treatment plan includes a combination of therapy and medication, especially for depression and anxiety disorders. However, many patients are hesitant to accept mental health referrals—sometimes because of stigma, but more often because of the challenge of finding the right, or any, mental health professional in their area.

Many areas of the country have few to no psychiatrists. And those that do often come with added barriers, like lack of insurance coverage or the dreaded, “I’m not taking new patients,” which I experienced even in the D.C. area. This makes it challenging for many to follow up with much-needed mental health care.

“One of the biggest challenges, and personal frustrations of mine, is getting patients set up with a quality, trusted mental health provider in their area,” explains Claudia. “Many times, all we can do is advise patients to contact their insurance companies for a list of covered providers in their area and hope they find someone who can help.”

From personal experience, it’s clear to me that my therapist is my one-stop-shop for maintaining my mental health. I can see her once a week, whereas I rely on an online messaging service to communicate with my PCP. I also know that my therapist’s background and training are in mental health, and she likely sees dozens of patients like me a week; mental illness is her specialty. Because of these reasons, it just makes the most sense to go to a mental health care professional if you’re seeking mental health care—if you can find one.

It really is up to the individual—and their loved ones by providing support and encouragement—to continue to seek out the best possible care they can. And while the care we receive from a PCP may not always immediately lead to mental health care, it is a step in the right direction. The most important thing is to start somewhere when seeking the help you need.

 

Click here to learn more about the several types of mental health care providers.

 

Ryann Tanap is manager of social media and digital assets at NAMI.

* Name has been changed

Note: This piece is a reprint from the Fall 2017 Advocate

Comments
James Jenkins
We at First Approach EA share the professional passion. Our current opiate crisis is truly a problem.
All hands on deck. You workout people Tylenol. Be safe Be well.
3/7/2018 12:26:13 PM

lashan d stephens
This was a very interesting article. This article has shown major flaws in our Health Care System, This article shows that there are inadequacies in treating depression.
1/30/2018 3:04:57 PM

DEbbi Bethel
I am having extreme difficulty finding AFFORDABLE care for my 29 yo son. I live in Vermont I need HELP. Rather my son needs help.
1/16/2018 10:01:37 AM

DEbbi Bethel
I am having extreme difficulty finding AFFORDABLE care for my 29 yo son. I live in Vermont I need HELP. Rather my son needs help.
1/16/2018 10:00:01 AM

George Patrin
This article points out how difficult it is to navigate the sick care system we have in this country to find quality health care, especially mental health care. The writer, and most Americans, have never experienced high quality integrated health care, unfortunately. The first stop when we feel our mental health is not good should be the Primary Care Provider. The Primary Care Team, which includes a nurse case manager, helps evaluate all possible reasons we may be feeling fatigued, depressed, or anxious. Often the cause can be hormonal imbalance (like the thyroid), not neurotransmitters in the brain (which medications help to rebalance). The best PCP office teams help rule out the most common causes of stress and depression and begin preliminary treatment while searching for a mental health professional. Your family provider also knows all the family and can discuss relationship issues as well as possible new diagnoses like bipolar and postpartum depression. The best Primary Care offices have a memorandum of agreement with a social worker, psychologist, or independent therapist to provide mental health care right there in the same office space, or closely aligned within the same community. Practitioners who have made this transformation have established Patient-Centered Care Medical Home (PCMH) practices. An integrated team approach, is more user-friendly to the patient, which makes sense. It's very difficult to have to go out searching for a specialist for mental health when it's our brain, and thinking processes, that are the issue. When enough consumers become aware this type of practice is available, and start asking for this type of service, more offices, both primary care and specialty care, will make the transformation and provide it.
1/14/2018 1:19:20 AM

Ellen
Into my first five minutes (first and last meeting) with a shrink-he gave me meds-that's all they do-"take this" and the rest of the time-pretending to "care"
1/13/2018 10:52:55 PM

Pam Sinnett
This blog was well written to clearly communicate her example of the process and very helpful, I think.
1/10/2018 4:55:42 PM

Betty Day
I only went to a psychiatrist when I fell off the edge of the earth into major depression because I knew from past experience with a therapist I met during couples counseling that if I ended up in court (job-related episode), only a psychiatrist would have the weight needed to speak to my issues in a way that a judge/jury would believe. I really didn't think there was anything wrong with me except I couldn't stop crying . . .
1/9/2018 9:14:31 PM

Sandi
Excellent post, and I couldn't agree more. PCP hand out meds and if one doesn't work, here's another. Been through this. All made me worse. In my opinion, they should not treat mental health issues. We are lacking care in this field and who do you turn to.
1/8/2018 4:07:38 PM

Laquivia
Why go to see a pcp when you can call to speak to a mental health professional? I do not understand this article.
1/8/2018 12:20:26 PM

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