When Your Family Doctor Is Also Your Shrink

Partner content from Kaiser Health News

Insurance coverage for mental health and treatment of substance abuse is getting big boost this year.

Implementation of a law that mandates equal coverage of physical and mental health treatment is picking up steam. Come 2014, the health overhaul law will require that insurance exchanges also guarantee coverage.

Still, the laws don't address one important fact: Many people get their mental health treatment from their primary care doctor, bypassing the traditional mental health system altogether.

And that may mean they don't always get the best treatment, advocates say.

Take depression, for example: 60 percent of prescriptions for antidepressants are written by primary care doctors, says Andrew Sperling, director of legislative advocacy for the National Alliance on Mental Illness.

Yet, cognitive behavioral therapy — working with a counselor to recognize and replace distorted patterns of thought — is known to be an effective treatment for depression without the side effects of antidepressants.

But an “ob/gyn who’s writing the prescription for an SSRI has no training in CBT,” says Sperling. SSRIs, or selective serotonin reuptake inhibitors, are a class of antidepressants that work by increasing the level of the neurotransmitter serotonin in the brain.  "So the question is, is that patient getting the full range of treatment options?" he asks.

A recent report from the Center for American Progress, a Washington think tank that supported the Democratic health overhaul, notes that the new law seeks to bolster primary care and those policies will likely continue the trend toward primary care treatment for mental health issues. But the report, by Leslie Russell, suggests that's not a bad thing.

Better integrating mental health coverage into primary care "would make a substantial contribution toward expanding access" for patients, the report says, "improving the physical health of people with mental illness and the mental health of people with chronic physical illnesses, and addressing current health care inequalities for people with mental health problems, especially for those who are from racial and ethnic minorities."

And the Obama administration is looking at it from the reverse angle as well. Last month, the Department of Health and Human Services announced a $26.2 million grant to help 43 community behavioral health centers put primary care into their services. "The long-established split between 'mental' and 'physical' health is not justified in research and should not be perpetuated in health care," HHS Secretary Kathleen Sebelius said at the time.

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