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

Table 1 Recommendations to improve treatment of common mental health conditions in primary care settings

Recommendations

(1) ACGME requirements should be amended to require dedicated time for primary care physicians to learn self-care/burnout prevention as well as basic problem-solving therapy and psychopharmacological care on outpatient psychiatry rotations or through internal medicine resident-run mental health clinics and for psychiatrists to learn how to supervise other clinicians, including but not limited to: social workers, psychologists, and primary care doctors who function as the primary prescribers; (2) Health systems should streamline communications systems (pagers, cellphones, telehealth) to create access to e-consultations for primary care doctors needing psychiatric expertise; (3) Financial models should align with the long-term need for indirect consultations as well as with new roles of primary care providers and psychiatrists within integrated care settings particularly in the post-COVID-19 financial milieu; (4) Integrated care models should leverage technology to fill administrative functions (such as tracking patient health questionnaire (PHQ-9 forms), develop guidelines for determining when and how to use smartphone treatment applications and self-care resources in primary care settings, and rapidly expand telemedicine to address workforce gaps particularly in socioeconomically disadvantaged groups who face technology-driven disparities; (5) Primary care practices must partner with psychiatry specialty services to create a robust process for referring appropriate patients to specialty mental health care; and (6) Real world effectiveness research should be conducted to elucidate the effectiveness of precisely and efficiently targeting screening and treatment recommendations according to patient phenotype, risk and preference

ACGME: Accreditation Council for Graduate Medical Education; COVID-19: Coronavirus disease 2019.