Primary care doctors are growing source of mental health counseling

Growing numbers of patients are getting mental health counseling from their primary care doctor, a trend that could boost support for value-based care models and change the organizational structures of primary care practices.

Those findings emerge from a new study looking at the impact of changes in the delivery of mental health services on primary care use and capacity. To find out, the authors analyzed data from the 2006-2018 National Ambulatory Medical Care surveys on about 110,000 visits to primary care physicians among adults 18 or older. They looked at whether a mental health concern was a primary diagnosis as well as if a mental health concern was addressed during the visit, even if not the main reason for the visit.

They found that the proportion of visits that had a mental health concern as its primary diagnosis grew from 3.4% in 2006-2007 to 6.3% in 2016-18. During the same period, the proportion of visits that addressed any kind of mental health concern went from 10.7% to 15.9%, an increase of nearly 50%. That compares to an 18.6% increase in the prevalence of any mental health illness among American adults during the approximate same period.

By a margin of 11.2% to 8.9%, patients were more likely to have mental health concerns addressed in a visit with their usual primary care physician than a visit with one who was not their usual primary care provider.

The mental health concerns being addressed in primary care visits changed during the study period. The percentage of anxiety and stress-related diagnoses increased from 29.4% in 2008-2009 to 34.5% in 2016 and 2018. On the other hand, the proportion of visits addressing depression and affective disorders dropped from 32.4% to 20.8%, and rates of serious mental illness from 5.4% to 3%.

The study also found significant race and ethnicity-based differences in the use of primary care visits for mental health reasons. Specifically, Black and Hispanic patients were 40% less likely than white and non-Hispanic patients to have a mental health concern addressed during a visit.

The authors cite two reasons for the growth of primary care clinicians treating mental health issues: the ongoing shortage of mental health specialists, and the growing embrace of the patient-centered medical home concept, which includes greater integration of behavioral health into primary care.

They add that the findings show the importance of providing primary care doctors with the tools for addressing patients’ mental health needs. Among these, they say, are co-located therapy or psychiatry providers, longer visit lengths, and billing codes and documentation systems that make it easier to address both mental and physical needs.

Moreover, the fact that patients are more likely to get mental health counseling from their usual primary care physician than with another provider “build on previous work demonstrating the importance of having an ongoing supportive relationship with a usual primary care doctor for addressing the full continuum of patient needs, and mental health needs in particular.”

The study, “Adult Primary Care Physician Visits Increasingly Address Mental Health Concerns” appears in the February, 2023 issue of Health Affairs.