Earlier this year, Cleveland Cavaliers player Kevin Love wrote a powerful piece for the Players' Tribune in which he detailed having his first panic attack, followed by a struggle to seek help. Love was inspired to come forward after Toronto Raptors All-Star DeMar DeRozan tweeted that he had also been grappling with depression.
Love and DeRozan are just two of the latest public figures to step forward and reveal that they have faced mental health challenges. Those of us who work in this field offer our thanks to the increasing number of athletes, actors and other celebrities who—by revealing that they have experienced depression, anxiety or other emotional issues—are helping to destigmatize mental illness and inspire more people to seek treatment.
This is one important step toward improving the mental health of our nation. But for too many years, we have failed to move the needle toward better mental health.
In December 1999, then-U.S. Surgeon General Dr. David Satcher issued Mental Health: A Report of the Surgeon General, the first-ever surgeon general's report on mental health. The report highlighted the fact that mental health issues were prevalent and that nearly 1 in 5 Americans experienced a mental disorder during any calendar year. Sadly, 56% of Americans who experience a mental disorder do not receive treatment and the majority of patients who need psychological care will never initiate seeking help from a mental health specialist.
Roughly half of all treatment for common mental conditions is provided in the primary-care setting, according to the National Institute of Mental Health. Problems such as depression, post-traumatic stress disorder, anxiety and substance use disorders may require psychological services that most primary-care practices do not have the time or expertise to provide.
Patients who get a referral to a mental health professional from their primary-care physician often do not make the appointment. This stems partly from patients' reluctance to describe their mental health issues to a new provider who is not part of the care team, and partly from the shame or embarrassment of admitting to having a mental health problem. This stumbling block can be removed if the primary-care provider can do a "soft handoff" to a mental health provider who is part of his or her team. While not all practices follow this model, it's a standard of care that consumers should look for when choosing a primary-care physician.
Integrated care teams can better address patients' needs by providing the full range of expertise in a collaborative approach. Having behavioral health specialists within primary-care practices overcomes the problem of patients failing to follow up on a referral to an outside practitioner. When physicians diagnose a patient with a condition that can be best treated by a psychologist or other mental health professionals, imagine how easy it would be to walk that patient down the hall to a specialist on staff—and not just for mental disorders. Having mental health practitioners in the same office means patients can get evidence-based treatments to help them change behaviors related to obesity, smoking, alcohol use and more.
The U.S. devotes only 5% to 8% of its healthcare spending to primary care. Higher-performing healthcare systems in other developed countries devote double that amount to primary care and better integrate behavioral health—with better outcomes to show for their investment. In Norway, for example, primary-care teams are required to have a psychologist.
Combining mental health services with primary care can save lives while decreasing costs and increasing quality of care. The passage of the Affordable Care Act opened the door to new patient-centered models of care. As a result, the number of mental health providers participating in integrated healthcare is growing as insurers and patients call for team-based care.
As our nation's healthcare system transitions away from walling off primary and specialty care, patient-centered treatment should be top-of-mind for providers and patients. We urge payers and healthcare systems to advance this integrated model and ask other professional associations to join the effort. As the federal government continues to explore new ways of reducing healthcare costs, it is a slam dunk for psychologists and other mental health professionals to collaborate with physicians in primary care, because good healthcare is a team sport.
Arthur C. Evans Jr. is executive vice president and CEO of the American Psychological Association. Ann Greiner is president and CEO of the Patient-Centered Primary Care Collaborative.
