Must mental health counseling take place on a couch? Not any longer, apparently.

A shocking number of family physicians are now integrating mental health care into their practices. Professionals in the mental health field aren’t confident that primary care docs are the best people to deal with mental illness.

There are not enough mental health care providers.

The American Psychological Association reports that more than 70 percent of visits to primary care physicians are related to psycho-social issues. One-quarter of adults experience a mental illness in a given year and more than half receive no treatment, according to the National Alliance on Mental Illness.

Getting necessary help is a good thing, of course — but are family doctors really the right place to turn?

For some people, going to their primary care physician is the only way they will seek treatment. A primary care visit is more readily covered by insurance, while ongoing therapy typically costs more out-of-pocket. In some cases, therapy can only be covered depending on the type of therapist a patient sees and if a separate mental health deductible is reached.

Many family doctors are capable of treating most mental health medication issues on their own, said Dr. Wanda Filer, a family physician in York, Pennsylvania. Family physicians still sometimes recommend talk therapy, but not all patients will consider the practice — although it is thought to work best in combination with medication on most issues. Filer said some practices offer a psychologist or psychiatrist in the same office.

“If a psychologist is integrated into the practice, that’s terrific. That makes it simple. The simpler the better,” Dr. Shoshana Bennett, a therapist from San Francisco, California, said.

Filer, president of the American Academy of Family Physicians, said the shift to primary care physicians is because there are not enough mental health care providers.

[lz_bulleted_list title=”Warning Signs of a Mental Health Condition” source=”http://www.nami.org”]Extreme difficulty concentrating or sitting still|Feeling sad or withdrawn for more than two weeks|Severe mood swings that cause problems|Intense worries or fears that hinder daily activities|Significant weight loss or gain|Severe out-of-control risk taking[/lz_bulleted_list]

She said doctors are learning about cognitive behavioral therapy and mental health medications more readily while they’re in school — enabling them to help most patients manage these issues.

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“There’s a lot more medications available these days,” Filer said. “The residents have a lot more resources at their fingertips.”

Patients with heart disease and diabetes, for example, are likely to experience depression, so seeing a primary care doctor may help them more easily comply with taking medication, Filer said.

She questions patients about their lives so she can see if they are experiencing a mental health issue, she said. Then she refers them for therapy if she thinks it may help. Having a therapist on staff is more convenient for larger practices. It also makes some patients more comfortable than having to go to a building that is known only for psychotherapy — many are embarrassed about seeking help.

“It’s a process,” she said. “For some patients, it’s really difficult to accept that referral.”

When It’s Not Appropriate
Filer spends a big part of her day talking to patients. But discussing conditions such as anxiety and depression is different than CBT and other techniques that many people need for true healing. That can be provided only by a therapist, including social workers, psychologists, and psychiatrists.

Bennett is happy people are seeking help, but isn’t sure a primary care doctor is always the best source.

“The whole answer does not come out of a bottle,” said Bennett, who wants to make sure people aren’t going to their doctors for a quick fix and ignoring talk therapy when it can be a life-saver.

A primary doctor may not be the best physician to manage psychotropic medications, as they are not trained in the intricacies of complex cases. Seeking treatment only from a primary care doctor could put patients at risk for misdiagnosis and erroneous treatment. A primary care doctor may diagnose a patient as depressed, for example, when that person is actually bipolar. But the doctor may never know it because the patient shows up only when he or she is depressed — not when manic.

“Primary doctors are typically not trained to be able to do a thorough assessment of what kind of medication the patient actually needs,” she added. “Most people can be prescribed an antidepressant by a primary doctor but sometimes it’s not an antidepressant that the person needs.” Bennett noted that sometimes talk therapy can resolve the issue.

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She cautions patients against relying on a doctor who seems to want to be a therapist as well.

“It’s very tempting for a caring professional to want to help in all ways,” she said. “To practice therapy without a license is not only inappropriate, it’s dangerous. Some very well-meaning practitioners step over that line.”

Bennett believes many family physicians can point their patients in the right direction, but believes that direction should be toward a psychiatrist for medication and a therapist for therapy.

“Support is great. Showing human-to-human contact is great,” she said. “Part of that support is putting the name of a psychotherapist in that patient’s hand.”