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Providing Mental Health Services in the Primary Care Setting: the Experiences and Perceptions of General Practitioners at a New York City Clinic

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Abstract

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.

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Acknowledgements

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.

Author information

Authors and Affiliations

  1. Mount Sinai Beth Israel Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 317 East 17th Street, 9th Floor, New York, NY, 10003, USA

    Issa Papiss Bagayogo

  2. Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA

    Katharina Turcios-Wiswe

  3. Department of Psychology, Oakland University, 654 Pioneer Drive, 123 Pryale Hall, Rochester, MI, 48309-4401, USA

    Kanako Taku

  4. Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA

    Lauren Peccoralo

  5. Department of Psychiatry and Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1257, New York, NY, 10029, USA

    Craig L. Katz

Authors
  1. Issa Papiss Bagayogo
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  2. Katharina Turcios-Wiswe
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  3. Kanako Taku
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  4. Lauren Peccoralo
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  5. Craig L. Katz
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Corresponding author

Correspondence to Issa Papiss Bagayogo.

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Ethical Approval

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.

Disclosures

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.

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Bagayogo, I.P., Turcios-Wiswe, K., Taku, K. et al. Providing Mental Health Services in the Primary Care Setting: the Experiences and Perceptions of General Practitioners at a New York City Clinic. Psychiatr Q 89, 897–908 (2018). https://doi.org/10.1007/s11126-018-9587-2

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  • DOI: https://doi.org/10.1007/s11126-018-9587-2

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