Who can you turn to when you’re feeling blue?
With not enough psychiatrists and other mental health professionals to fill the need – and an increase in the number of behavioral health issues facing the population, primary care doctors are now playing a bigger role in diagnosis and treatment.
According to the Association of American Medical Colleges, the nation has a shortage of psychiatrists and other mental health professionals, while one in five Americans has a mental health condition. The National Alliance on Mental Illness says primary care physicians often fill the need for mental health diagnosis, treatment and management.
“Primary care, we have to be a little bit of everything, and that includes psychiatry,” said internal medicine physician Peter Crosson, MD, who practices at Medical Affiliates of Cape Cod’s Strawberry Hill Primary Care in Hyannis.
Mental health and physical health affect each other, he said. For example, a cancer patient’s diagnosis may cause depression, and anxiety can worsen a patient’s high blood pressure.
“You really have to take both into account when treating a patient, if a treatment is going to be successful,” he said.
Dr. Crosson asks patients about symptoms that may indicate mental health issues, such as insomnia or little interest in food. Nurses in the office also ask about depression symptoms when preparing a patient for a physical exam, he said. For older patients, depression screenings follow a format set by Medicare, which covers them.
Dr. Crosson said he doesn’t just write prescriptions. He also refers patients to community resources, such as the Visiting Nurse Association of Cape Cod, Elder Services of Cape Cod and the Islands, town senior centers, mental health counselors and addiction treatment centers, including Gosnold, Inc.
“For a lot of patients, medicines alone aren’t enough,” he said.
Depression and Substance Abuse
Among older patients, who may be isolated and ill or caring for a sick partner, depression is not unusual, Dr. Crosson said. Some will self-medicate, often with alcohol. They may become suicidal.
To help counter feelings of loneliness and being overwhelmed by caretaking responsibilities and financial worries, Dr. Crosson said he will recommend tapping local services, such as respite care that allows a caretaker spouse to get out of the house.
“Sometimes they just are not aware of it (available help), or think they can’t afford it,” he said.
For patients facing a tough diagnosis or chronic pain, Dr. Crosson said he takes a similar approach of treating depression and informing them that they don’t have to deal with their problems alone.
“There is help out there for things like household stuff and finances,” he said.
The prevalence of alcohol and drug abuse on Cape Cod presents a complex challenge for physicians, Dr. Crosson said.
“Substance abuse disorders often co-exist with mental health problems,” he said. “That co-morbidity is very common,” he said.
Effective treatment happens when patients trust him and open up about their addictions.
“I usually ask them directly,” he said. “They won’t always be honest about how much.”
If he suspects opioid abuse, Dr. Crosson said he can check a state database for a patient’s narcotic prescriptions.
“You have to understand, they’re afraid of losing access to the drug they’re using,” he said. “I tell them, ‘We’re going to help you and work on it as a team.’”
Tips for Talking
The National Institute of Mental Health urges people not to wait for your doctor to ask about mental health issues, but to bring up their concerns. The organization offers these tips:
- Before your visit, write down your questions. Bring a list of medications and any relevant family history (some behavioral health disorders are hereditary).
- Consider bringing a friend or family member to listen to all the doctor says and for emotional support.
- Be truthful and complete about recent major events or stresses. Describe symptoms that may include changes in diet or sleep habits, loss of interest or energy, difficulty being still, persistent sadness or irritability, feelings of worthlessness or suicidal thoughts, and pains, headaches and digestive problems that have no obvious cause.
- If you have questions about your diagnosis or treatment options, ask your provider.