The Integration of Mental Health into Primary Care

| June 20, 2013 | 2 Comments

Mental health is one of the biggest problems facing modern medicine today, yet it is often overlooked in terms of primary care. Not only do mental disorders have a heavy economic and social burden on society, but also few of those who need assistance with mental disorders actually receive the treatment they require. In order to close this gap in mental health treatment and increase access to mental healthcare, mental health services should be integrated into primary healthcare through health policy legislation and education of primary care workers.

Up to 60% of individuals who visit primary care clinics have a diagnosable mental disorder.[1] This staggering statistic highlights the pressing need for mental health to be included in primary care, as combining the two systems would greatly increase access and system efficiency. Not only are mental disorders widely prevalent—the WHO estimates that depression afflicts 154 million people worldwide—but also they hold severe consequences and burdens if left untreated.[1, 2] Individuals with mental illnesses are often ostracized from normal society—sometimes even abandoned by their own families—and are at higher risk for living under the poverty line and becoming homeless.[1] Thus, mental check-ups should be incorporated into routine health check-ups, as this would would increase efficiency, de-stigmatize mental disorders, and reduce discrimination against individuals with mental disorders.

Additionally, mental and physical health problems are strongly interconnected. Co-morbidity between mental disorders and many physical diseases such as HIV/AIDS, cancer, tuberculosis, and diabetes is common.[2] Our thoughts, feelings, and behaviors have an enormous impact on our physical well-being, just as our physical health influences our mental well-being. For example, stress and anxiety worsen physical health just as how having a physical medical condition causes stress and anxiety. Thus, it only seems logical to combine mental and physical healthcare into one service for a more holistic, successful approach to care and treatment.

In order to successfully implement the integration, action must be taken to enact new health-policy legislation and educate primary-care health workers to address mental health concerns. It is crucial to pass legislation that emphasizes incorporating mental health into general primary care in order to receive governmental support and funding for this process. This legislation should focus on establishing mental health facilities at every clinic or health center, including having mental health specialists on-site in order to support primary-care workers. Additionally, nurses and physicians must be trained to diagnose common psychological conditions, such as depression or schizophrenia. Primary-care workers should also be able to treat these common mental disorders with prescription medication, although counseling should still be left to psychological specialists.

We can model integration of care based on other countries’ systems that have been successfully integrated. For example, the Ehlanzeni District of the South African province Mpumalanga possesses a thorough model of care that treats mental health problems the same way as any other health problems; the same practitioners see patients with mental illnesses and those with physical ailments, and nurses are trained to evaluate both mental and physical maladies. This systemic method allows for holistic, effective healthcare.

Mental healthcare is every bit as essential and important as physical healthcare. These two aspects of health are strongly interconnected and should be integrated into one comprehensive system in order to increase access to and treatment of mental illnesses as well as to de-stigmatize mental disorders. President Obama has already taken the first steps in de-stigmatization by holding a mental health conference at the White House and launching community summits to assist war veterans suffering from mental health problems. [3] Hopefully, Congress will follow Obama’s lead in spotlighting mental health by establishing new policies and legislation, as much remains to be done to promote good mental healthcare. Ultimately, the goal of medical healthcare is to ensure both the physical and mental well-being of all, and primary healthcare must be changed to reflect that.

A mental health patient is seen by a primary-care physician.

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Footnotes:

1.) WHO & Wonca. 2008. Integrating mental health into primary care: a global perspective. <http://www.who.int/mental_health/policy/Integratingmhintoprimarycare2008_lastversion.pdf>.

2.) Funk, M., Saraceno, B., Drew, N., & Faydi, E. 2008. Integrating mental health into primary healthcare. Mental Health in Family Medicine. 5(1): 5-8.  <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777555>.

3.) Dann, C. “Six months after Newtown, Obama spotlights mental health.” NBC News 6 June 2013. Web. <http://nbcpolitics.nbcnews.com/_news/2013/06/03/18723173-six-months-after-newtown-obama-spotlights-mental-health?lite>.

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