Although behavioral and physical health are deeply intertwined, the two forms of care are often siloed in a poorly coordinated system. And patients often fall through the cracks of the disjointed system when they are referred to an outside specialist.
The appointment started out routine enough: a patient in need of help for high blood pressure. Then, said Kristen James, a family medicine doctor-in-training, the patient started crying, and it turned into a mental health visit.
"We artificially separate 'this is a mental health issue' and 'this is a physical health issue,'" said Lisa Barkley, a doctor and director of the family medicine residency program at Charles R. Drew University of Medicine and Science, where James is training. "But really, people are just coming in for their issues."
The barriers to care are many: provider shortages, high out-of-pocket costs, gaps in insurance coverage, stigma and shame. For marginalized communities, the obstacle course to access includes additional hurdles added by centuries of racial animus, class resentments and geographic isolation. If patients need support beyond what primary care providers can offer, they don't have to go somewhere else to get it with an integrated care model, often on-site. In such a setting, there's a behavioral health team, social workers, therapists or psychiatrists. Experts say this helps foster discretion and dignity, because people could be sitting in a waiting room for myriad reasons.
"Montana only has 1 million people total, but if you look corner-to-corner across the state, it's the same distance from Chicago to Washington, D.C.," said Julie Kelso, a psychiatrist and faculty member with the Montana Family Medicine Residency, which is based at an integrated primary care clinic where she is a staff member.
In October, the U.S. Preventive Services Task Force recommended all 12-to-18-year-olds be screened for depression and 8-to-18-year-olds for anxiety, noting that a constellation of factors, such as the trauma of losing a parent, increases risk.
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