Integrating Psychiatry Into Primary Care

TORONTO — Psychiatrists need to consider several factors including location, coordination and communication when integrating mental health services with primary care, according to a presentation made at the American Psychiatric Association Annual Meeting.

It is estimated that only 14% of patients with mental health problems receive psychiatric care, while nearly 80% of patients see a primary care provider. “Primary care is really point of entry care,” said Nick Kates, FRCPC, MCFP, of McMaster University in Hamilton, Ontario, and colleagues. “One of the goals of integrated care is to provide more — and better — mental health care through collaboration.”

Kates, and co-presenter Jon Devine, MD, CCFP, RCPC, also of McMaster University, discussed several considerations mental health practitioners can do to help better integrate care.

First, communication methods need to be improved between mental health and primary care clinicians. Mental health providers can simplify intake procedures, review inclusion and exclusion criteria with primary-care providers (PCPs), providing information sheets with discharge summaries, and the rapid transmission of reports.

“Notes don’t need to be lengthy,” emphasized Kates. “They need to be helpful, practical, and they need to be delivered  quickly — just the salient points.”

Another opportunity for collaboration stems from the consultation stage of care. Psychiatrists can set up a rapid consultation service and provide telephone back-up and advice, not just for patients, but for PCPs who have questions. “I’ve found that most family physicians really look for collaboration during consultation,” added Devine.

Next, more attention needs to be paid to the coordination of care, according to the presenters. Mental health care providers can develop a discharge planning check list. “We have eight things we need to do before we send a patient back to their family physicians,” said Kates.

When it comes to better coordination of care between mental health services and primary care, psychiatrists should involve PCPs and patients in the treatment plan. “Let everyone know what’s happening so that everyone is on the same page,” suggested Kates.

Another important part of integrative care is the post-discharge follow-up. When primary-care clinicians are kept abreast of a mental health plan, it’s easier to spot a recurrent problem. When the PCP is involved, it’s easier to “bring someone back in for a booster or a reassessment before waiting months before the condition deteriorates.”

Co-location, through joint rounds and educational sessions with mental health providers and PCPs provide opportunities to meet. Psychiatrists can pay visits to primary care offices for consultation, follow-up, and case reviews.

“If you’re going to better integrate mental health into primary care, you need to understand the primary-care ethos: flexibility,” said Devine.

“When we look at how we can improve our services, we need to listen to PCPs are telling us,” added Kates. “We need to hear what the constituencies we’re trying to serve tell us.”

Reference

Kates N, et al. “Integrating psychiatrists within primary care settings: practical tips and tools.” Presented at: APA 2015. May 16-20, 2015; Toronto, Canada.