Adding Counseling to Doctor Visits

The problem? Mental health problems occur throughout many people’s lives and yet they don’t seek out specific help for them. Instead, they turn to their primary care physician to help relieve associated physical complaints. Don Sapatkin, writing for The Philadelphia Inquirer, has the story:

Mental health traditionally has been considered a specialist level of care, and often requires a referral. Yet huge numbers of people go to their doctor for problems that have a behavioral component: headache, fatigue, even diabetes that is out of control because stress has gotten in the way of refilling a script.

Some have a serious problem but don’t want to see a specialist; more antidepressants are prescribed by primary doctors than by psychiatrists. Others have less significant behavioral issues, such as difficulty getting to sleep, that may not warrant referral to a specialist.

What to do? You aren’t going to easily change the entire population’s behavior by just offering better services (even if they’re online), or less expensive services, or more readily accessible mental health services — people just aren’t that interested.

So if you can’t bring the person to the therapist, why not bring the therapist to the person?

Specifically, schedule a brief counseling visit while the patient is being seen by the doctor for their physical complaints. This helps everyone — the overworked doctor, who isn’t a specialist in mental health problems to begin with; the patient, who needs some specific guidance and an empathetic ear to hear their stress and associated complaints; and the therapist, who often wouldn’t get to see these patients because they would never come to the therapist’s office.

It’s called “behavioral health” to differentiate it from general mental health and emphasize its focus on helping people change problematic behaviors that are impacting their general health. The term is also sometimes seen as less stigmatizing as “mental health” and therefore may be more readily accepted by the patient who would otherwise not talk to a counselor.

How it works is simple: A trained behavioral health specialist (e.g., a therapist with specific training in this type of intervention) gives a brief, 15- to 30-minute intervention while a patient is seeing their primary care physician. The focus of the intervention is to address problem behaviors in the person’s life that may be a contributing factor to their health concerns — such as how to better handle stress, tips and skills-training for overwhelmed parents of a toddler, grappling with a grief reaction due to a traumatic event.

The impact on depression, which has been studied the most, appears to be similar to traditional therapy – but integrated care reaches far more people.

That has ripple effects for the growing population with chronic illnesses, especially in low-income communities.

“If you are depressed, you are not as able to do the things that manage these illnesses: good diet, exercise, taking medication to manage the illness,” said Hyong Un, the Blue Bell-based national medical director for behavioral health at Aetna, whose foundation is aiding the integration at six health centers in Philadelphia.

Entwining services can have a large impact. “If I can do something that’s timely or focused that helps you quit smoking, then I’ve done something more for your health than anybody else can do for you,” said Alexander Blount, director of behavioral science in the family medicine department at the University of Massachusetts Medical School.

Everyone seems to like these interventions but here’s the kicker — most insurance companies don’t pay for them! Therefore you won’t find them in your local doctor’s office anytime soon unless it’s a part of an integrated care delivery system, such as Kaiser Permanente in Northern California, federally funded health centers, and Veterans Affairs medical centers.

We fully support the use of integrative care in primary care physician’s offices and hope that insurance companies will come around in understanding their benefits and ability to reach (and therefore, positively impact) many people’s lives who ordinarily would never receive such interventions.