PCPs: are you playing offense or defense with your patients’ mental health?

*This blog highlights key points discussed during Myriad Neuroscience’s March 1, 2022 webinar: “Are you playing offense or defense with your patients’ mental health? Enhancing your treatment playbook”

The panel featured:

	Crystal Nelson, MD – owner and psychiatrist at Blueprint Psychiatry in Newnan, Ga.
	Robin Miller, MD, MHS – internist at Triune Integrated Medicine in Medford, Ore.
	Charles Cook, DNP, FNP – family nurse practitioner at The Oaks Internal Medicine & Endocrinology in Winston-Salem, N.C.

More than 112 million Americans live in areas with a shortage of mental health specialists, according to the Commonwealth Fund.

Experts say this gap will widen over the next few years due to a rising demand for mental health services and changing demographics among mental health professionals. In fact, a National Council for Behavioral Health report estimated that by 2025, the demand for psychiatry will outstrip supply by 15,600 psychiatrists.

This places primary care providers (PCPs) – like family practitioners, internists, social workers, OB-GYNs, advance practice nurses and more – at the front lines of an escalating mental health crisis.

Our panel of experts explored opportunities for PCPs to collaborate with mental health specialists and how tools can help time-strapped clinicians with treatment decisions.

Primary care practices see rise in mental health concerns

The panel started the discussion with how changing mental healthcare dynamics and external factors like a global pandemic have increased the frequency and severity of mental health needs of their patients.

“Mental health is always important in my practice,” said Dr. Miller. “I have noticed an amazing amount of anxiety in people that I never would have expected to be anxious – including some of my friends. And the people who had anxiety to begin with are far worse.”

With higher demand, mental health practices are increasing their staff, sometimes calling professionals out of retirement. “We definitely are at crisis level,” said Dr. Nelson.

Dr. Cook added that many patients are experiencing longer wait times to see a healthcare provider. He says the typical wait time to get an appointment with a mental health specialist can be three to six months. As a result, he is seeing more patients who are experiencing mental health issues in his practice.

Tools can help primary care providers identify and treat patients

PCPs time is valuable and in short supply. So, finding adequate time to talk through mental health concerns with a patient is a challenge, given the number of patients scheduled in a given day.

The panelists explored how tools like depression screening and pharmacogenomic (PGx) testing, including the GeneSight test, can be used to help primary care providers and mental health professionals collaborate to provide the best overall care for their patients.

Depression screening

In the time Dr. Cook typically spends with his patients, he uses PHQ-9, PHQ-4, and/or GAD-7 scales to screen for depression and anxiety as well as the ISI to scan for insomnia. Screening for depression is important because depression is one of the leading co-morbidities of several physical health conditions, such as diabetes. Dr. Cook says it can be difficult to treat chronic diseases without addressing co-morbid depression.

Further, depression screening saves time for themselves, their patients, and other providers. However, Dr. Cook highlighted the importance of carefully listening to understand the patient’s concerns.

“Taking the time to sit down and talk with the patient, listen to them, see what their needs are, is critical,” said Dr. Cook.

Dr. Nelson advises primary care providers to have an action plan in place should a patient’s screening indicate a depression or anxiety diagnosis. Action plans may vary, but they could include a medication prescription and/or referrals to a therapist, psychiatrist or another mental health specialist.

PGx testing

Dr. Nelson says one of the most helpful actions primary care providers can take before referring patients is to offer the GeneSight test.

“For a primary care doctor, once they identify depression or anxiety, to do a GeneSight test really would cut down on some of the referrals I even get from the start,” said Dr. Nelson. “If they were GeneSight tested and a medication choice is made with as much information as it gives, [patients] might get better outcomes, period, and not have the need for psychiatry.”

Dr. Cook explained that using the GeneSight test may help primary care clinicians by giving them additional information for choosing a medication, versus just using family history, prior experience with a medication or other factors.

By having a GeneSight report, Dr. Nelson shared psychiatrists can more quickly and easily identify next steps for referred patients who have failed multiple medications. Ultimately, the panelists agreed the GeneSight test helps to foster a collaborative relationship between primary care and mental health specialists.

“GeneSight has been revolutionary for my practice,” said Dr. Miller. “It has made such a difference, because I have a much better idea on how to choose medications.”

View the full webinar for more conversation about applying the GeneSight test in primary care practices.

For more information about the importance of depression screening in primary care, visit our blog. If you’re interested in registering to order the GeneSight test, you can take the next step here.