Opinion: Mental health needs must return to primary care conversation

Separating mental health care from physical health care was one of the great medical care blunders of our time.”

We have an access problem.

Our country has a significant shortage of high-quality mental health providers, and at the top of the list is a severe shortage of child psychiatrists.

If your child is recommended to see a psychiatrist, you will typically wait six to 12 months. Can you imagine having a child who is struggling with depression or anxiety, even attention deficit hyperactivity disorder, and you have no access to a professional who can help?

The Mercy Kids/Mercy Virtual program, which was featured in the Wall Street Journal in January, is a great example of a solution.

With mission in mind, Mercy focused on providing families with access to basic mental health care in their medical homes. We trained our pediatric providers, developed electronic health record-based tools, and we provide on-demand support by a team of psychiatric experts housed at the Mercy Virtual Care Center, in Chesterfield. Our pediatric providers can get answers to questions about diagnoses or treatment, and in a crisis, we can provide an immediate telemedicine evaluation or consultation.

But this is not traditional telepsychiatry. We are truly collaborating with the pediatric provider to make a diagnosis and begin treatment the day the child arrives in the office. No more waiting six to 12 months.

The benefit of this upstream solution is that fewer kids visit the emergency room, fewer kids are unnecessarily hospitalized, parents miss less work and kids miss less school.

Separating mental health care from physical health care was one of the great medical care blunders of our time. Years ago, the primary care physician cared for all aspects of their patients’ lives, including their mental health.

Today, as we try to cope with the shortage of psychiatrists, reintegrating mental health care into the medical home is paramount. When we can get comfortable again talking with our primary care provider about our emotions as well as our arthritis and high blood pressure, then we’ll stand a chance to heal as a community.

Talking about our emotional health is also one way to reduce the ridiculous stigma associated with mental illness. Given that mental illnesses, such as depression and anxiety, are more common than diabetes and heart disease, it seems odd that we would mark it with some type of scarlet letter.

Reintegrating mental health care into the medical home, demanding parity in coverage for mental illness and refusing to believe that mental illness is some sort of personal flaw or the result of poorly made decisions are all ways our community can put an end to the lie that mental illness is any less of a medical problem than diabetes or heart disease. We simply cannot afford to look upon mental illness as anything less than what it is, a group of brain-based illnesses, genetically transmitted, affected by our habits and life-stressors, and responsive to proven therapies that can restore us to health. Sounds like diabetes and heart disease, doesn’t it?

Transformative downstream solutions are needed as well as increasing upstream access, and Mercy has recently partnered with Burrell Behavioral Health to help manage our inpatient psychiatry programs; this collaborative approach is vital to the success of providing more and better care. Many of our patients require the type of services that only our Certified Community Behavioral Health Centers can provide, so this partnership will benefit our community.

Our current system of mental health care is broken, and it can’t be fixed by hiring more psychiatrists, because there simply are not enough available. We must design a team-based approach to care, we must collaborate with our primary care and community partners, and we must increase timely access to care if we’re going to make any meaningful progress in addressing our mental health care crisis.

Dr. Kyle John, medical director of Mental Wellness at Mercy Virtual in Chesterfield, can be reached at MercyVirtual.net/contact.