Can Primary Care Physicians Address the Behavioral Health Crisis?

In a recent Senate Finance Committee hearing, U.S. Surgeon General Vivek Murthy, MD, MBA, said, “We are on the verge of beating back one public health crisis in COVID-19, only to see another grow in its place … We have the opportunity and the responsibility to make change happen now.”

Murthy was referring to what we as a nation face today: A growing and undeniable behavioral health crisis. A proven solution to remedy this is to better integrate behavioral health services into primary care settings and realign payment and delivery systems to help physicians meet the growing and diverse behavioral health needs of their patients.

Given that primary care physicians are likely to be the first point of contact for patients needing mental health care — and may be the only source of such care for many patients — integrating mental health services and primary care resources is essential. Fortunately, our country’s strong team of family physicians stands ready to work with policymakers to improve access to these essential services — but they must be appropriately resourced to do so.

While treating behavioral health has been increasingly prominent, primary care physicians can’t always do this work alone — we rely on other behavioral health professionals for referrals, some serious mental illness treatment, support, and more. The growing shortage of healthcare professionals who work alongside us prevents Americans from accessing the comprehensive healthcare services they desperately need. This is especially true for many Black and Hispanic individuals, who are more likely to have untreated mental health needs than white individuals, compounding racial inequities.

As practicing family physicians, my peers and I diagnose and treat behavioral health concerns every day. Managing behavioral health is a core tenet of medical education and residency programs for family medicine, and trusted family doctors are well-equipped to identify and meet our patients’ behavioral health needs through early identification and ongoing care management.

Currently, access to comprehensive behavioral health services are unevenly distributed throughout the U.S., and roughly two-thirds of primary care physicians are unable to connect their patients to outpatient mental health services in a timely manner. As a result, many primary care physicians have assumed a leading role in managing these more complex behavioral health challenges, but they are doing so without the support of an adequate physician payment system that reflects these important responsibilities.

The nation could benefit from directing more attention toward incorporating behavioral health into primary care. This integration exists along a spectrum ranging from consistent coordination of referrals and exchange of information to locating behavioral health services within the primary care office.

However, there are several barriers to integrating behavioral health into primary care practices. These include a limited workforce, payment and reporting requirements, and steep start-up costs. We need a paradigm shift to support behavioral health treatment in our communities and to empower patients to access that care.

Far too many Americans face barriers to care, including a shortage of behavioral health professionals and the stigma associated with behavioral health issues that permeates relationships, workplaces, and even our own healthcare system — but we can’t change the trajectory by ourselves. With worsening adult mental health concerns and a children’s mental health national emergency, it’s time to integrate primary care and behavioral health services, including the consolidation of school-based services and primary care, as well as maintenance and expansion of state, federal, and private insurance funding of behavioral health care services for all. As primary care providers and family physicians, we know the signs and we know our patients.

We ask our nation’s leaders to support family and other primary care physicians’ efforts to integrate these necessary services.

Sterling N. Ransone Jr., MD, is a family physician and president of the American Academy of Family Physicians