The Interface between Primary Care and Behavioral Health Thursday, August 8, 2013

As we go through our live, events may occur that derail us. Maybe it is the death of loved one, a divorce or loss of a job or even a high level of stress in our lives. A person may start to wonder if this is just regular sadness and worrying or are they developing a clinical depression or anxiety disorder. Where should this person turn to for some initial screening and help? Most people do not know a psychiatrist or a psychiatric nurse practioner. The health care provider who is familiar to them is their own doctor, the person who takes care of them when they have the flu or the pediatrician who take care of their children. Our primary care physician offices are often the best known, most familiar connection we have with the health care world. It is a good place to turn to and seek help if your health care concerns now include some mental health issues. Most antidepressant prescriptions in America are written by primary care physicians [family practioners, internist, and pediatrician] and also by Physician assistant and nurse practioners working in a primary care setting. Often many people with mild to moderate depression many never see a psychiatrist. They see their internist or family practioners or sometimes their Ob-Gyn physician and get started antidepressants. They may in addition go to see a therapist, such as a social worker, marriage and family therapist or a psychologist. However, if the mental illness is more complex such as bipolar disorder or a severe depression that is not responding to antidepressants or the patient requires a complicated medication regimen, then the primary care physician will refer the patient to see a psychiatrist. In the United States today there is a shortage of psychiatrists and also of primary care physicians. With the shortage of psychiatrists, including child psychiatrists and also of , psychiatric nurse practioners, access to see them in a timely manner is often very challenging. As health care reform helps more and more Americans to get health insurance, they will try and access care including treatment for any psychiatric condition. If they find they are unable to access a psychiatrist easily, they do have another option, as long as they have a primary care doctor. Getting help for any mental health issue early when it is at a relatively mild stage is very important to prevent the condition from getting worse. A good place to start would be your own doctors’ office.