Treat 'whole person' by bringing behavioural health into primary care: Docs

In a new position paper, the American College of Physicians (ACP) lays out six strategies for bringing mental health and substance abuse care into primary care to better treat each patient as "a whole person."

Mental and behavioural health issues like inappropriate eating behaviours, sedentary lifestyle, and patterns of social isolation, are common, and have been linked to increased physical illness, higher mortality rates, poorer treatment outcomes and higher healthcare costs, the ACP committee writes in the Annals of Internal Medicine.

"The literature shows that most people with behavioural health needs access the health care system through their primary care physician or other health care professional," said lead author of the statement Ryan A. Crowley, senior health policy analyst for the ACP.

"Patients who exhibit physical ailments - such as chronic diseases like diabetes - often have behavioural health problems that may affect their physical care needs," Crowley told Reuters Health by email.

In the statement, the ACP recommends integrating behavioural healthcare into primary care by removing financial barriers, closing insurance coverage gaps and using government incentives to train and educate an adequate number of providers to administer behavioural health care in the primary care setting.

More research is needed to define the most efficient approaches for integrating care and efforts should be made to remove the lingering stigma associated with mental healthcare, both among the general public and among physicians themselves, the statement notes.

"People might think of behavioural health as stigmatizing and wouldn't think of going to specialised care for it," said Constance M. Horgan of the Institute for Behavioral Health at the Heller School for Social Policy and Management at Brandeis University in Waltham, Massachusetts.

Delivering mental healthcare in the primary care office, where so many people already go, could help bridge that gap, said Horgan, who was not involved in the ACP statement.

"There certainly are people who need the specialty system, so the primary care system certainly should be in a position to refer to specialty systems," she said. Though these resources may be available in many communities, many primary care providers don't know about them, or how to hand off a patient into specialised care, she said.

Placing a behavioural care specialist in primary care offices would help make those connections, she said.

"In some cases some physicians may not know how to ask difficult questions," like inquiring about signs of alcohol abuse, Horgan said. Those providers may need specialised training in how to deal with substance abuse.

The Supreme Court decision to uphold the Affordable Care Act (ACA) should help to address some of the barriers to integrated care, she said.

"Not only has the ACA helped increase the number of people with comprehensive, affordable health coverage, but it requires many plans to cover essential health benefits that include mental health and substance use disorder services including behavioural health treatment and preventive services (e.g., substance abuse screening) without cost sharing," Crowley said.

"We hope that all states will choose to expand Medicaid coverage, which includes behavioural health and medical benefits," he added.

"Physicians can establish professional relationships with behavioural health providers to facilitate referrals when needed; they can educate themselves on screening and diagnostic protocols and understand what, if any, treatment they can provide their patients; they can educate their patients on behavioural health issues," Crowley said.