Primary Care & Mental Health
It can be difficult talking about mental health concerns. There is still a stigma attached to mental illness, which may prevent people from getting the help they need. But mental disorders are so common that 1 in 5 Americans will deal with mental illness at some point in their lives—and many of these conditions are treatable. According to the National Institute of Mental Health, approximately 47 million U.S. adults grappled with some type of mental, behavioral or emotional disorder in 2018. Only 43 percent of those patients requiring treatment received it.
What percent of primary care visits are mental health?
The impact of these conditions can vary, ranging from mild to moderate to severe impairment. That’s why it’s best to address problems head-on, before symptoms have a chance to get worse. But people are often unsure of where to turn for help. Although many patients might not consider their primary care doctor when they have mental health issues like depression, anxiety, eating disorders and addiction, primary care physicians are often the best medical resource to start with.
Is mental health part of primary care? Do you talk to your primary care doctor about mental health?
You may feel embarrassed and wonder how to bring up mental health with your doctor. Remember that doctors hear everything in their practices. Primary care physicians and family doctors are generally trained to treat the entire patient – not just your physical health, but mental and emotional health issues as well. In fact, your doctor prefers that you speak up rather than hold back information that may affect any aspect of your well-being.
These days, the COVID-19 pandemic is giving rise to a wide range of psychiatric problems suitable for discussion at your family doctor’s office or through telehealth visits. Social isolation, anxiety, educating children at home, unemployment and financial difficulties are all taking a toll on patients’ mental health. The pandemic can exacerbate symptoms for those with pre-existing mental health conditions. Frontline healthcare providers are experiencing increased workload and trauma, especially when infection spikes occur in their area. Reports of burnout, depression and post-traumatic stress disorder (PTSD) are increasingly common. PTSD is also taking a toll on those traumatized by natural disasters, such as wildfires or hurricanes, and those who experience or are witness to violent assaults.
Mental Health: Diagnosis and Treatment
Turning to your primary care doctor for help can be a logical starting point, especially if you’re comfortable talking with him. A doctor will typically start with one or more mental health screenings, which involve asking you questions about your symptoms, when they started, and how they’ve impacted your life at home and at work. A family doctor may already be aware of some personal events in your life, such as loss of a loved one or a divorce. When partnering with a doctor for your good health, having this kind of rapport can be a comfort and it can assist your doctor in providing comprehensive care.
Before making a diagnosis, a primary care physician may conduct a physical exam, review your medical records and medications, and possibly order lab tests to rule out any medical conditions that may be causing your symptoms.
Once a diagnosis is reached, treatment depends on the condition and severity of it. A family doctor may suggest lifestyle changes that can improve your mental health, such as exercise and getting enough sleep. He/she may start you on a low dose of medication. Several follow-up visits will be needed to see how you progress. If sufficient progress isn’t made, your doctor may change medications. They may also suggest psychotherapy, such as cognitive behavioral therapy (CBT), and help with finding a provider. Meanwhile, a doctor will continue to manage your medication and monitor your progress.
A patient with a condition that is more difficult to treat, such as bipolar disorder or schizophrenia, will likely need treatment by a psychiatrist. Your family doctor can continue to track your treatment and possibly take over the role of prescribing medication refills.
How Does Mental Health Affect Physical Health
Since mental health issues are often influenced or co-morbid with medical problems that primary care doctors regularly treat, they are well-suited to help. Stress and anxiety can take a significant toll on your physical health if left unaddressed. It can contribute to problems such as high blood pressure, heart disease, obesity and diabetes. Excessive anxiety has been linked to a variety of illnesses, such as heart disease, digestive problems and pain.
Depression is one of the most common mental disorders in the U.S. According to the American Academy of Family Physicians (AAFP), the effect of depression on chronic medical disease management is grossly underestimated: Patients with depression experience a higher incidence of premature death related to cardiovascular disease and are 4.5 times more likely to suffer a heart attack than those without depression.
Depression is more prevalent for women, than men – almost twice as common. Risk factors according to medcial research include biological factors such as hormonal issues and premenstrual problems, perimenopause and menopause, pregnancy, being in a postpartum period — and lifestyle factors including unequal power and status, work overload and physical or sexual abuse.
For men, there is a combination of risk factors, studies say. Money stress, a difficult relationship, work problems or job loss can all trigger depression. In both genders, illnesses like diabetes, heart disease or Parkinson’s disease can also play a role. At times medications taken for these conditions can cause side effects that trigger or worsen depression.
Do I Need to See My Doctor for Mental Health?
While every condition has its own list of symptoms, some overlap with other disorders—one reason why diagnosis can be challenging. Here are some of the more common symptoms that could signal something is wrong:
- Ongoing headaches
- Feeling sad, empty, hopeless
- Upset stomach
- Incessant worry
- Concentration and memory problems
- Irritability, anger or aggressiveness
- Lack of motivation
- Extreme mood changes
- Withdrawal from friends or activities
- Fatigue, inability to sleep or sleeping too much
- Alcohol or drug abuse
- Persistent, frightening thoughts
- Feeling detached or numb
If you’re feeling symptoms like these, start a conversation with your primary care doctor. Don’t have a primary care doctor? Consider joining an MDVIP-affiliated primary care practice. Doctors in the MDVIP program see fewer patients and have more time to focus on your health holistically – including your mental health. Mental wellness screeners are part of the annual MDVIP Wellness Program, and your MDVIP-affiliated primary care physician can help assess mental health issues such as depression, stress and anxiety.