The percentage of primary care visits addressing mental health concerns increased from 10.7% in 2006 and 2007, to 15.9% by 2016 and 2018.
That’s according to a recent study published in Health Affairs that shows a growing involvement of primary care clinicians in addressing behavioral health concerns. As part of the study, researchers analyzed a sample of 109,890 visits that took place between 2006 to 2018.
“One in four U.S. adults had anxiety or depressive disorder in 2021. And there’s a shortage of psychiatrists,” Dr. Lisa Rotenstein, co-author of the study, told Behavioral Health Business. “So in that context, we found that the proportion of primary care visits addressing mental health concerns increased almost 50% from 2006 to 2018.”
In addition to being one of the lead researchers in the study, Rotenstein serves as the medical director of population health at Brigham and Women’s Hospital’s Primary Care Center of Excellence.
Rotenstein and her team found that the proportion of mental health primary care visits addressing anxiety and stress increased over time. In 2006 and 2007, 29.9% of mental health primary care visits addressed anxiety. That number spiked to 38% from 2014 and 2015, and 34.5% in 2016 and 2018.
Meanwhile, serious mental illness was the least addressed topic in mental health primary care visits across all years.
Primary care physicians (PCPs) are well-equipped to handle many behavioral health conditions, according to Rotenstein. But for more complex cases, an integrated approach is crucial, she noted.
“Primary care providers are a great starting point for addressing mental health concerns. This is the right work for primary care physicians to do,” Rotenstein said. “And there’s a certain set of diagnoses that they are really comfortable treating, so many primary care providers are really comfortable treating anxiety, depressive symptoms, etc. But to really deliver good, effective mental health care requires time and a multidisciplinary approach.”
The research found that mental health concerns were more likely to be addressed if a patient was seeing their typical doctor.
“Patients were more likely to address a mental health concern or have a mental health concern addressed in a visit with their usual primary care physician rather than another PCP,” Rotenstein said. “And so what this really emphasizes is the importance of longitudinal relationships.”
While behavioral health has become a more common topic in primary care visits, there are still some barriers for specific demographics.
The research demonstrates that Black patients were 40% less likely than white patients to have a mental health concern addressed in a primary care visit. Additionally, Hispanic patients were 40% less likely to have a behavioral health concern addressed than non-Hispanic patients.
“There are often barriers for patients to receive services outside of primary care, but our findings even suggest that there are barriers within primary care,” Rotenstein said. “To effectively meet these population needs, we need to understand a little bit better what it is that is preventing Black and Hispanic patients from having mental health concerns addressed in the context of primary care as frequently. Is it that they’re being screened less often? … I think that is an area of research our study has emphasized the need for.”
To improve patient care, Rotenstein said that a collaborative care approach is a must.
“PCPs, although really well equipped at baseline for this demand, need reimbursement systems that give them the time to spend with patients to deliver these services, and resources that build a team around them,” she said. “So this could be like co-located therapy or psychiatry, eConsult services where psychiatrists support PCPs, longer visit links, etc.”
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