Should your primary care doctor be doing more for your mental health?

medical_110006299-011314intThink of the last time you saw your primary care doctor- maybe you went because you had the flu, maybe it was for a work/school physical, or if you’re really on top of things you have an annual check-up just because it’s a smart thing to do. Regardless of the reason you were there, did they ask you any questions about your mental health? Mental health screening by a primary care doctor is a great way to identify mental health concerns before they reach a crisis stage. NPR did a very interesting story recently on the efforts of the Henry Ford Health System to reduce the number of suicides amongst patients to zero, beginning with a simple screening process by the primary care physician:

Primary care doctors screen every patient with two questions: How often have you felt down in the past two weeks? And how often have you felt little pleasure in doing things? A high score leads to more questions about sleep disturbances, changes in appetite, thoughts of hurting oneself. All patients are questioned on every visit.

Early intervention is critical and getting people help before they decide to attempt suicide or engage in self-destructive behaviors is one of the simplest things that can be done to treat mental health. But how many primary care doctors ask these questions or use another screening method with patients?

I’m not saying that primary care screenings are going to be the ultimate panacea when it comes to mental health, after all, if patients aren’t willing to be open with their primary care doctor about mental health issues or, for that matter if they don’t even see a primary care physician on a regular basis it won’t matter. Additionally the ability of the primary care physician to make referrals and for the patient to be able to cover the costs of treatment are hurdles that need to be addressed for early interventions to work. The Affordable Care Act was an important step to address some of these issues by expanding the availability of health insurance to help cover the costs, and the Mental Health Parity and Addiction Equality Act makes sure that insurance covers mental health related treatments, but more needs to be done.

I understand that there’s a ton of pressure on doctors as it is to screen for things like cancer risk, heart disease, etc. and that even if screenings for mental health are done it can be hard to know what steps to take next to refer patients to additional help. Some physicians may also be just as uncomfortable talking about mental health as their patients. From the NPR piece:

Today, providers are trained to be comfortable asking their patients about suicidal thoughts. “There is a fear among clinicians that if you ask questions about suicide, you are giving the patient an idea that this could be an option,” says Espiritu, “and if you ask about guns or pills, that you are giving them some hints on how they can carry out a plan.” The Henry Ford therapists are trained to break that barrier.

Both doctors and patients will need to become more comfortable treating mental health as part of the total picture of healthcare. That involves breaking down stigmas and stereotypes about mental health, about suicide and making it clear that help is available. So let me return to the question I asked at the top- Did your doctor ask you about your mental health the last time you saw them? And more importantly, would you feel comfortable answering those questions?

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