The Rise in Mental Health Illness Inevitably Affects the Primary Care Clinician: What You Can Do For Your Patients
Author: Christine Zink, MD
Mental health illness is rising exponentially in the US, and the opportunity for caring for patients is falling into the hands of primary care clinicians. This post covers the changing statistics and reasons for the rise in mental health problems, how psychiatrists and psychologists cannot meet patient care demands alone, and how primary care clinicians can help ease mental health illness in the US.
Here are the key takeaways:
- Approximately four in 10 US adults report anxiety or depression, up from one in 10 who reported symptoms in the first part of 2019.1
- 20% of young adults and adolescents have seriously considered attempting suicide, and 9% have attempted suicide.2
- Nearly half of psychologists indicate they cannot meet the demand for mental health treatment services and feel burned out.3
- In the 1990s, the percentage of patients who received psychiatric medication from primary care clinicians increased from 37% to 75%. Currently, primary care clinicians prefer managing mental health concerns in their patients independently rather than referring them to a mental health specialist.4
- The American Academy of Family Physicians outlines four reasons primary care clinicians should embrace the mental health care needs of patients, including patient needs, improved clinician skills, financial savings for the system, and enhanced reimbursements for individual clinicians and practices.5
Growing Mental Health Needs
It’s no secret that mental health illnesses, particularly anxiety and depression, have been rising since before the COVID-19 pandemic and have grown exponentially since 2020. The World Health Organization (WHO) recently reported that the global prevalence of anxiety and depression increased by 25% during the first year of the pandemic.6 The increase has primarily been attributed to6:
- Social isolation
- Constraints on the ability to work
- Lack of support from loved ones
- Little engagement in the community
- Fear of COVID infection
- Suffering and death for oneself or loved ones
- Grief after bereavement
- Financial worries
During the pandemic, approximately four in 10 US adults have reported symptoms of anxiety or depression, which is up from one in 10 adults who reported symptoms in the first part of 2019.1
A particular demographic that has been hit hard by mental health concerns is young adults and older adolescents. During the pandemic, just over half of all young people have reported symptoms of anxiety or depression.1 Young adults also report increased substance use and suicidal thoughts compared with other adults.1 A survey conducted on adolescents in grades nine through 12 from January to June 2021 showed that 37% of students have experienced poor mental health during the pandemic, 20% have seriously considered attempting suicide, and 9% have attempted suicide.2 The researchers were able to determine from this work that a primary factor leading to feelings of sadness or hopelessness in this population is the feeling of a lack of connectedness with others during the pandemic.
These numbers are shockingly high and concerning for young Americans. Compounding the problem further is the lack of access to adequate medical care during the pandemic, leaving many people with mental disorders without treatment. Several mental health and primary care practices closed or limited services during the pandemic, which stymied any improvement in psychiatric care. This lack of access continues today because of a dearth of clinicians and the increased number of people who need care.6
Mental Health Clinicians Cannot Meet the Needs Alone
In late 2021, the American Psychological Association (APA) surveyed US adults to analyze the impact of mental health and the need for care by psychiatrists and psychologists. Most psychiatric clinicians reported increased demand for treatment of anxiety, depression, sleeping disorders, obsessive-compulsive disorder, and substance-related and addictive disorders.3 Psychologists also reported increased referrals and growing wait lists they would never see the end of.3 Nearly half of psychologists indicated they could not meet the treatment demand and felt burned out.3
In addition, many US urban and rural areas do not have mental health clinicians. More than one-third of the US population lives in an area with mental health clinician shortages.7 In some places, it takes an average of 25 days for new patients to be seen by a psychiatrist.7 Outside of major cities, seeing a clinician can take much longer. Nearly 65% of nonmetropolitan areas lack a single psychiatrist, and almost 50% lack a psychologist.7 The sparse placement of mental health services has led to a crisis where only half of the people with mental health disorders have ever received treatment. And these numbers describe the map before the COVID pandemic.
During this ongoing crisis of increased mental health needs and lack of access to appropriate care, the primary care clinician is needed more than ever and will be the backbone of physical and mental health improvement in the US.
Primary Care Clinicians Have Been Taking the Lead on Managing Common Mental Health Illnesses
As is well known and experienced by seasoned primary care clinicians, over the last few decades, the delivery of mental health services has changed significantly and landed in the hands of primary care clinicians. In the 1990s, the percentage of patients who received psychiatric medication from primary care clinicians increased from 37% to 75%.4 Since that time, primary care clinicians have been the major caretakers of depression and have preferred caring for their patients independently rather than referring them to a mental health specialist.4 The potential advantages of having primary care clinicians manage common psychiatric disorders, like depression and anxiety, are4 :
- Coordination of care for mental and somatic disorders
However, there are challenges in having primary care clinicians manage these illnesses, such as misdiagnosis (i.e., bipolar disorder) and mistreatment.
The expanded role of primary care clinicians in managing mental health disorders means clinicians have improved their ability to diagnose and treat common psychiatric disorders. And now, more than ever, those skills are being tested as primary care clinicians are relied upon in more significant numbers to address the rising physical and mental health care needs of people after the COVID-19 pandemic.
And, the problem of increased need will not be going away anytime soon. It’s better understood that mental health affects physical health and vice versa. Not only are people in dire need of mental health services, but the effects of anxiety and depression on their physical health are increasing healthcare needs overall.
Furthermore, experts indicate that the mental health impact of disasters outlasts the physical impact. One study showed the psychological toll on clinicians during significant outbreaks and found that psychological distress can last up to three years after the episode.8 Due to all of the other life concerns affecting all people (i.e., poor economy), experts anticipate that additional deaths due to suicide and substance use will continue to rise through 2029.1 One of the best ways to slow these rising numbers is to encourage more mental health services by primary care clinicians.
The Importance of and How to Best Offer Offer Mental Health Services as a Primary Care Clinician
Addressing the mental health needs in the US is daunting, however, organizations like the AAFP have ideas on how primary care clinicians can improve their practice patterns and systems to address the onslaught of patients and needed services. They encourage5:
- Telemedicine use – Telemedicine gives broader access to timely care and offers patients privacy in the comfort of their homes during visits.
- Appropriate screening – The AAFP recommends screening for both mental and physical health. All patients should be screened appropriately so that mental health issues do not contribute to worsening medical problems. This means screening patients on exercise, diet, weight, substance use, sleep, and cancer.
- Use of collaborative care models – Incorporation of collaborative care models can reduce costs, improve clinical outcomes, and enhance treatment adherence when managing mental illness and physical conditions.
- Education – Education prepares clinicians to manage mental health issues responsibly. The AAFP not only encourages CME/CE for the practicing clinician but also stresses the need for graduate medical education to address the diagnosis, management, and coordination of care for common mental illnesses.
Mental health care needs have reached crisis levels and primary care clinicians will play a key role in addressing this challenge. As a leader in CME/CE since 1995, Pri-Med can help you stay up to date on the latest in mental care and manage common mental health concerns. For additional resources, view our psychiatry CME/CE.
- 1. Panchal N, Kamal R, Cox C, Garfield R. The implications of COVID-19 for mental health and substance use. Published February 10, 2021. Accessed July 12, 2022. https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/
2. Jones SE, Ethier KA, Hertz M, et al. Mental health, suicidality, and connectedness among high school students during the COVID-19 pandemic – adolescent behaviors and experiences survey, United States, January-June 2021. MMWR Suppl. 2022;71(3):16-21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8979602/
3. American Psychological Association. Demand for mental health treatment continues to increase, say psychologists. Published October 19, 2021. Accessed July 12, 2022. https://www.apa.org/news/press/releases/2021/10/mental-health-treatment-demand
4. Abed Faghri NM, Boisvert CM, Faghri S. Understanding the expanding role of primary care physicians (PCPs) to primary psychiatric care physicians (PPCPs): enhancing the assessment and treatment of psychiatric conditions. Ment Health Fam Med. 2010;7(1):17-25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2925161/pdf/MHFM-07-017.pdf
5. Kieu A. Now more than ever, mental health care needs family medicine. Fam Pract Manag. 2021;28(3):11A-11C. https://www.aafp.org/pubs/fpm/issues/2021/0500/oa1.html
6. World Health Organization. COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. Published March 2, 2022. Accessed July 12, 2022. https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide
7. Benders-Hadi NS, Taylor P. Why primary care clinicians are key to identifying and addressing behavior health stressors. Published September 22, 2021. Accessed July 12, 2022. https://opmed.doximity.com/articles/why-primary-care-clinicians-are-key-to-identifying-and-addressing-behavioral-health-stressors?_csrf_attempted=yes
8. Kisely S, Warren N, McMahon L, Dalais C, Henry I, Siskind D. Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis. BMJ. 2020;369:m1642. https://www.bmj.com/content/369/bmj.m1642