Primary Care Physician: First Step Toward Mental Healthcare

It’s easy to understand why you might want to skip your primary care physician and head straight to a specialist when faced with a specific health problem. If the problem involves mental health, you may even be unaware of the care your general practitioner can provide.

But absent a true emergency, the best starting place to treat both physical and mental illness is at the office of your primary care provider. That’s because our healthcare system is designed as a pyramid, with primary care as a gateway to manage care.

To preserve this hierarchy, many health insurance policies, including health maintenance organizations and point-of-service providers, require a primary care provider’s referral before paying for you to see a specialist.

People visit their family doctors for many reasons, including an annual physical exam, cough, sore throat and back pain.

Visits for depression or anxiety also are common. In fact, primary care physicians take 40 percent of all office visits for mental health concerns and write 47 percent of all psychiatric prescriptions.

Getting To Know You

The terms general practice, family practice and primary care all refer to healthcare professionals who are trained to diagnose and treat common medical conditions, manage treatment of more serious conditions and provide vaccinations and advice to keep patients healthy.

It’s important to establish a relationship with your primary care provider through annual wellness exams and office visits when hurt or ill; they are trained to understand that physical health and mental health are intertwined. If you are in poor physical health, you have a significantly higher risk of developing mental health problems, including depression, anxiety and substance abuse disorders.

The better your doctor knows you, the better they will understand changes in your physical or mental well-being to direct you to the care you need.

How To Talk to Your Doctor About Mental Health

Mental illness is a leading cause of disability in the United States, affecting about 23 percent of all adults and 17 percent of youth at some point. Signs of mental illness include:

• Persistent feelings of sadness, emptiness, guilt or worthlessness
• Feelings of hopelessness or pessimism
• Anxiety
• Irritability
• Loss of interest or pleasure in hobbies and activities
• Decreased energy or fatigue
• Moving or talking more slowly
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering or making decisions
• Sleep disorders, including trouble falling asleep, staying asleep or oversleeping
• Appetite or weight changes
• Thoughts of death or suicide

Despite its prevalence, more than half of people with mental illness don’t seek care, often because they fear stigma and discrimination still associated with disorders of the mind.

Because of these fears, primary care providers are trained to watch for signs of mental illness in patients they see regularly.

But as a patient, you have a role, too: Talk to your primary care provider about your concerns. Be honest, and be as specific as possible about when symptoms started, their severity and frequency. Let your doctor know of any life changes that could have triggered these symptoms or stressors that may be making them worse.

The next step is likely to be a simple, in-office screening tool like the Patient Health Questionnaire, which asks about the frequency of depressed mood. Upon diagnosing a mental illness, your doctor can discuss treatment options, which may include medicine.

The Role of Specialists

As long as your mental health concern is something your primary care provider sees regularly, they will be able to diagnose and treat it. Should that treatment prove unsuccessful, your doctor may consult with or refer you to a specialist — a healthcare professional with training in a specific field.

Both neurologists and psychiatrists are medical doctors who specialize in the brain and nervous system, but their roles are distinct: Neurologists focus on physical disorders like epilepsy, stroke and Parkinson’s disease; psychiatrists focus on mental health issues like anxiety, depression, bipolar disorder and schizophrenia. Other mental healthcare specialists to consider include:

• Psychologists, who may hold master’s or doctoral degrees and often perform formal assessments to diagnose specific mental health disorders
• Licensed professional counselors, who provide various types of therapy for individuals, couples, families and groups to improve mental and behavioral health
• Social workers who have received additional training in psychotherapy
• Psychotherapists, a term that includes many mental health professionals who provide forms of psychotherapy, also known as talk therapy

Treating Depression and Anxiety

If you are diagnosed with anxiety, depression or both, your doctor may recommend an antidepressant. Several types are available that work in different ways, so don’t be discouraged if the first one you try doesn’t work. Also keep in mind that antidepressants can take several weeks to be fully effective, and they don’t work for everyone.

Medicines often work best in combination with improved self-care (regular sleep, exercise and a nutritious diet) and psychotherapy. The latter is a catch-all term that involves talking about your thoughts, feelings and behaviors in a safe, confidential setting with a trained therapist, whose role is to help you identify and change troubling thoughts and emotions.