Primary care and mental health: Where do we go from here?

Abstract

Primary care has been dubbed the “de facto” mental health system of the United States since the 1970s. Since then, various forms of mental health delivery models for primary care have proven effective in improving patient outcomes and satisfaction and reducing costs. Despite increases in collaborative care implementation and reimbursement, prevalence rates of major depression in the United States remain unchanged while anxiety and suicide rates continue to climb. Meanwhile, primary care task forces in countries like the United Kingdom and Canada are recommending against depression screening in primary care altogether, citing lack of trials demonstrating improved outcomes in screened vs unscreened patients when the same treatment is available, high false-positive results, and small treatment effects. In this perspective, a primary care physician and two psychiatrists address the question of why we are not making headway in treating common mental health conditions in primary care. In addition, we propose systemic changes to improve the dissemination of mental health treatment in primary care.

Keywords: Mental health; Collaborative care; Primary care; Depression; Integrated care; Anxiety

Core Tip: Primary care has been dubbed the “de facto” mental health system of the United States since the 1970s. Two psychiatrists and an internist at a major academic medical center review difficulties with implementation of collaborative care in academic primary care settings along with novel recommendations to improve dissemination of this evidence based practice.