Providing Mental Health Services in the Primary Care Setting: the Experiences and Perceptions of General Practitioners at a New York City Clinic
- 466 Downloads
Mental illness is a significant cause of disability worldwide, including here in the United States. Given the shortage of trained mental health professionals, a significant portion of patients needing care are managed in the primary care setting. Accountable Care Organizations (ACOs), for example, are seeking to improve the quality of care for this vulnerable population, but many are facing significant challenges relating to integration of new services. We sought to elucidate barriers faced by primary care practitioners (PCPs)—physicians, physician trainees and nurse practitioners—at a New York primary care clinic, which impede delivery of optimal care to those suffering from mental illness. The study was conducted with 32 PCPs in 2016–2017 at Mount Sinai Internal Medicine Associates in New York City. For the quantitative component of the study, a 54-item questionnaire was devised to assess their attitude, behavior and confidence in managing psychiatric patients. For the qualitative component, data was obtained from 3 open-ended questions. Responses were coded for salient themes. Analysis revealed a range of difficulties faced by PCPs. Overall, participants felt that the need to integrate mental health care into primary care was important, however they reported significant barriers in terms of lack of time, lack of resources, low confidence in treating more complex mental health conditions and difficulties with referring patient to mental health specialists. Despite a growing body of evidence that integration of mental health services in primary care leads to improved outcomes, addressing barriers to care will be key to ensuring feasibility of integration measures.
KeywordsMental health services Integrated care Primary care Global health New York City Health policy
We would like to thank all providers that took part in this study.
Mount Sinai Internal Medicine Associates.
Icahn School of Medicine at Mount Sinai (ISMMS).
Arnold Institute for Global Health-Global Mental Health Residency Track at ISMMS.
Mount Sinai Beth Israel Department of Psychiatry.
Compliance with Ethical Standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was determined to be exempt research by the Mount Sinai Program for the Protection of Human Subjects.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
This manuscript has not been previously published and is not under consideration in the same or substantially similar form in any other peer-reviewed media. All authors listed have contributed sufficiently to the project to be included as authors. To the best of our knowledge, no conflict of interest, financial or other, exists.
- 2.Disease, G.B.D., I. Injury, and C. Prevalence, Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet, 2017. 390(10100): p. 1211–1259.Google Scholar
- 3.World Health Organization. The global burden of disease: 2004 update. Geneva, Switzerland: World Health Organization; 2008.Google Scholar
- 4.Substance Abuse and Mental Health Services Administration (SAMHSA). Key substance use and mental health indicators in the United States: results from the 2016 National Survey on drug use and health. Substance Abuse and Mental Health Services Administration (SAMHSA). (HHS publication no. SMA 17–5044, NSDUH series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, substance abuse and mental HealthServices administration. Retrieved from https://www.samhsa.gov/data/, 2017.
- 6.Crowley RA, Kirschner N, Health and Public Policy Committee of the American College of Physicians. The integration of care for mental health, substance abuse, and other behavioral health conditions into primary care: executive summary of an American College of Physicians position paper. Ann Intern Med. 2015;163(4):298–9.CrossRefGoogle Scholar
- 18.Butler M, Kane RL, McAlpine D, Kathol, RG, Fu SS, Hagedorn H, Wilt TJ. Integration of Ment Health/Subst Abus and Prim Care No. 173 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290–02-0009.) AHRQ Publication No. 09-E003. Rockville, MD. Agency for Healthcare Research and Quality. October 2008. .Google Scholar
- 21.Loh DA, et al. Knowledge and attitudes towards clinical depression among community medical providers in Gujarat, India. Psychiatry Q. 2017;Google Scholar