Readers Write: Primary Care Mental Health Support Requires a Whole-Person Care Approach

Primary Care Mental Health Support Requires a Whole-Person Care Approach
By Cynthia Horner, MD

Cynthia Horner, MD is chief medical officer of Amwell. 

Primary care physicians started seeing a dramatic uptick in the number of patients with mental health concerns even before COVID took a toll on the country’s mental health. Now, as the nation struggles with record-high rates of distress and a lack of access to mental health support, there’s a critical need for the healthcare industry to embrace an integrated, whole-person approach to care.

Nearly one out of four adults experienced a mental, behavioral or emotional illness of some type in the past year, according to the latest report from the Substance Abuse and Mental Health Services Administration. For primary care physicians, the swell in the need for mental health support reflects a pattern they have seen during the past two decades:

• From 2006 to 2018, primary care visits that addressed mental health concerns grew 50%, from 10.7% to 15.9%, according to a study in Health Affairs.
• Between 2016 and 2018, about 40% of patients who were diagnosed with anxiety, depression, or any mental illness saw their primary care physician for treatment.
• The percentage of people suffering from anxiety and depression has doubled since before the pandemic. Medicaid data illustrates the enduring impact of COVID, with prescriptions for mental health-related conditions outpacing prescriptions for other conditions in 2022.

To help as many people as possible, we must initially reach patients where they are most likely to be seen: by their primary care providers.

The shortage in the behavioral health workforce may be why more people are turning to primary care physicians for support. The National Center for Health Workforce Analysis reports that as of December 2023, more than half the U.S. population—169 million Americans—lives in a mental health professional shortage area. Compounding the issue is a lack of primary care physicians to meet patients’ health needs.

Given the shortfall of mental health and primary care professionals, virtual care is vital to ensuring that patients have access to the right resources for a whole-person, integrated approach to care. Adopting hybrid care models that include telehealth is crucial to closing care gaps and enabling continuity and access for all.

Primary care physicians have a foundational understanding of mental health conditions. However, a whole-person approach to care — including comprehensive and ongoing mental healthcare from digital programs and behavioral health specialists — is vital to positive outcomes.

That’s one reason why it’s important to continue managing patients even after referring them to a specialist for support. This integrated approach can effectively bridge the gap between physical and mental health.

When it comes to which mental health conditions primary care providers should treat, the acuity matters more than the diagnosis. For example, earlier in my career as a family medicine physician, I managed a patient who was living with schizophrenia. His condition was well controlled and he complied with his regimen and his follow-up. For these reasons, I could continue to treat him. But had his disorder been more acute, or if he had been a new patient and the severity of his schizophrenia was unclear, I would have referred him to a behavioral health specialist.

Ideally, even after that referral, I would have remained part of his care team, received progress updates, and helped manage his other care needs. That’s the best scenario for patients and their primary care providers when they begin working with a mental health professional and receiving care through digital programs.

Whole-person care—delivered in-person, virtually, and through automated care—facilitates collaborative care. It removes the challenges of geography at a time when nearly 80% of U.S. counties are considered healthcare deserts. Whole-person care also offsets the challenges that patients face when they need support from a behavioral health specialist but can’t find one.

As the industry looks for ways to integrate mental healthcare into the primary care setting, here are ways providers can foster whole-person care for overall patient well-being.

• Lean into virtual technologies for support. With virtual primary care, network providers can manage referrals and care across digital behavioral health, urgent care, specialty care programs, and digital companions. This facilitates personalized care and optimal health outcomes by giving providers medical and mental health updates, helping to inform clinical decisions. Embracing virtual technology also minimizes instances where underserved communities can’t access the support they need. Today, 60% of psychologists report that they do not have openings for new patients.
• Establish stronger relationships between primary care providers and behavioral health specialists. Care teams that share assessments, treatment plans, and test results support an integrated model for healthcare. The adoption of health tech solutions nurtures this collective approach to care. It also improves the patient experience and helps align specialty referrals and digital care program enrollments, which empower patients to take an active role in improving their health.
• Partner with health plans to provide the right support for digital populations. This may include investment in a platform that blends in-person care with digital health tools. Evidence shows that patients who are receiving primary care services regularly see 33% lower healthcare costs. In 14 studies that examined the relationship between engagement and efficacy, 64% found that increased engagement with digital interventions was significantly associated with improved patient outcomes.

The movement of patients who are seeking care for mental health conditions from trusted primary care physicians isn’t going to slow or reverse. The industry can strengthen health outcomes by embracing a whole-person care approach, in-person and virtually. We can also keep primary care providers close to a patient’s physical and mental health care, offering the complete, integrated, and personalized support that patients want and need.