Patrick Kennedy, a former congressman from Rhode Island and son of the late Sen. Ted Kennedy, is using his policymaking experience and recent memoir to try to drive the mental health crisis into the presidential election conversation. His efforts and dedication are most certainly laudable.
The talk in mental health circles is that this vital treatment is a forgotten civil right. With $100 billion in lost productivity every year because of untreated or undertreated mental illness, it's a critical issue.
Kennedy rightly promotes integrating behavioral healthcare into the medical care Americans are already receiving, especially since stigma still keeps millions out of traditional mental health settings. Research from the American Psychiatric Association estimates that across some insured populations $293 billion could have been saved in 2012 through care integration.
One tactic is to meet patients where they are most receptive to treatment—in the offices of their primary-care physicians. This setting is where mildly to moderately ill patients first bubble up with often-vague but troublesome complaints like backaches, headaches, dizziness and stomach pain. Depression and anxiety are quite often the cause of physical symptoms with no medical explanation. Some 85% of antidepressant prescriptions are already being written by family doctors.
Kennedy's proposed program locates a mental health professional on-site at the primary-care office—a noble idea—but one with limitations. Co-location does not equal integration. Without blending medical records and collaborating around medication, interactions and side effects, diet, sleep and any diseases, the care is still siloed. Another problem unaddressed by the Kennedy plan is the dearth of primary-care physicians, psychiatrists and psychiatric nurses, and whether there are enough appropriately trained people distributed throughout the population to meet its needs.
An alternate starting point is a telephonic/telehealth model with patients in the privacy of their homes. A conversation about the primary medical condition creates an entrée for a behavioral health clinician to understand what underlying psychosocial factors may be inhibiting care and compliance, including undiagnosed or untreated mental illness. Psychosocial impediments like depression and anxiety often stymie the sickest patients, who account for a huge share of healthcare spending. Such interventions have proven effective in creating better outcomes for patients.
It is indeed surprising that we don't hear more about the costly mental health crisis in an election year. It isn't as drama-filled as the campaign repartee making headlines. Let's reorient priorities and have a conversation about this civil right whose turn has come.
Dr. Sam Toney is a board-certified psychiatrist and chief medical officer for Health Integrated, a Tampa, Fla.-based care-management organization.
