Research Highlights Primary Care’s Role in Mental Health

The study — “Assessing Primary Care Contributions to Behavioral Health: A Cross-sectional Study Using Medical Expenditure Panel Survey,”  published in the June issue of the Journal of Primary Care & Community Health — assessed primary care contributions to behavioral health using 2016-18 Medical Expenditure Panel Survey data. Its findings reinforce what previous studies have indicated: that primary care physicians deliver a substantial portion of mental health services in ambulatory settings.

“Primary care physicians provided most of the care for depression, anxiety and AMI (any mental illness),” its authors conclude. “Almost a third of the care for SMI (severe persistent mental illness) and a quarter of the SMI prescriptions occurred in primary care settings. Our study underscores the importance of supporting access to primary care given primary care physicians’ critical role in combating the COVID-19 related rise in mental health burden.”

Particularly given what the authors characterize as an underfunded mental health system and a strained primary care workforce, policymakers must invest in primary care practices to answer mental illness increases driven by the public health emergency, the report says.

“The pandemic has profoundly impacted the mental health of the public,” the study’s lead author, RGC researcher Anuradha Jetty, M.P.H., said in a news release accompanying the report’s issue. “With nearly 80% of the U.S. population experiencing mental stress due to the COVID-19 pandemic, this research underscores the importance of supporting access to primary care — both during and after public health emergencies.”

“There will undoubtedly be a surge of patients with unmet mental health needs due to the COVID-19 pandemic,” the study says.

“The historic pattern of primary care provision of mental health services that we demonstrate in this study sheds light on capacity of primary care to address mental health needs post-COVID-19. Primary care physicians are essential in addressing the nation’s mental health crisis. Their role as first-contact providers of comprehensive and continuous care makes them well suited to treat any mental illness.”

Indeed, the authors add, primary care physicians already perform the largest proportion of mental health care in the United States.

“Addressing mental health issues in primary care settings not only improves access to mental health care but, for some patients, also reduces the stigma associated with seeking care in mental health clinics,” the report says. “In addition, integrated behavioral and primary care models have shown to be effective in delivery of high-quality mental health care and in treating physical and mental health problems in primary care settings, particularly during the COVID-19 crisis.”

The Academy has led advocacy efforts to increase access to primary care and integrated primary and mental health care during and beyond the pandemic, in keeping with its extensive mental health policy. 

A free AAFP resource, “Addressing Behavioral Health Issues During the COVID-19 Pandemic: A Comprehensive Educational Program,” launched in March. Developed for physicians and clinical care teams by the Academy through a grant from Molina Healthcare, it’s one of several CME products on behavioral and mental health produced by the Academy. Several articles on the subject also are available in an FPM Topic Collection.

The AAFP is also a member of the recently formed Behavioral Health Integration Collaborative, eight physician organizations working together to incorporate behavioral and mental health into overall health care and increase patient access to behavioral health services in the primary care setting.