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.