Psychiatry and primary care

Show Notes

Lorenzo Norris, MD, interview with Robert McCarron, DO, at the American Psychiatric Association meeting (#APAAM19)

Dr. McCarron is vice chair of education and integrated care at University of California, Irvine, department of psychiatry. He is also trained as an internist.

Shortage of psychiatrists, other mental health providers

• About 70% of all psychiatrists are over the age of 50 years and looking toward retirement.
• This also pertains to other mental health providers, such as psychologists.

Implications of shortage

• People with severe mental illnesses (SMIs) are not getting the care they need. On average, they die 10-15 years younger than people who do not have SMIs. Patients with SMIs have a higher risk of death from illnesses such as heart disease, hypertension, and osteoarthritis because they are not getting preventive/primary care.
• Patients with chronic pain issues are not getting care.
• In California, physician assistants provide care to many patients, but they get only 2 weeks of instruction in psychiatry.
• About 80% of all antidepressants are prescribed by nonpsychiatrists. About 60% of all mental health care is delivered in the United States by clinicians who do not specialize in mental health. This care is delivered in primary care settings. About 40%-45% of patients seen in primary care offices are treated for behavioral health issues, such as depression, anxiety, or substance use disorders.
• Suicides are up more than 20% over the last decade. On average, 25 veterans die by suicide each day.

Training primary care colleagues in psychiatry

• Primary care physicians have a core baseline in biomedical sciences. Giving them a booster in behavioral health is a way to address the shortage.
• The Train New Trainers Primary Care Psychiatry Fellowship was launched at University of California, Davis, and the University of California, Irvine. It has 125 fellows throughout the country, and the hope is to double that number.
  • The program lasts 1 year, including two intensive weekends.
  • It teaches fellows how to conduct motivational interviewing; short, targeted, and brief psychotherapies that are effective and evidence based.
  • The Fellowship includes Web-based presentations two to three times per month.
  • It also includes small group mentorship meetings in which fellows discuss patients and learn how to navigate complex cases.
• A combined residency program might be another way to address the need for more training in psychiatry.

References

Price S. Front line: Using primary care to prevent suicide. Tex Med. 2018 Nov 1;114(11):16-21.

Santiani A et al. Projected workforce of psychiatrists in the United States: A population analysis. Psychiatr Serv. 2018 Jun;69(6):710-3.

Huff C. Shrinking the psychiatrist shortage. Manag Care. 2018 Jan;27(1):20-2.

Wilkins KM et al. Integration of primary care and psychiatry: a new paradigm for medical student clerkships. J Gen Intern Med. 2018 Jan;33(1):120-4.

McGough PM et al. Integrating behavioral health into primary care. Popul Health Manag. 2016;19(2):81-7.

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