Practices Are Developing Ways to Diagnose Mental Illness

By Diana George Chapin, Bangor Daily News, Maine

Sep. 30–Healthcare professionals maintain that up to 40 percent of those diagnosed with a mental illness receive treatment from their primary care physician (PCP). Neil Korsen, M.D., a primary investigator with the Depression in Primary Care Research Program at Maine Medical Center in Portland is helping PCPs become increasingly skilled in the diagnosis of mental health issues.

Korsen’s goal is to assist primary-care practices to develop systems of depression care that are evidenced-based and patient-centered. “We want to help primary care physicians have the tools and the approaches necessary to recognize and treat common mental health disorders as patients come to their doors and seek care,” Korsen reports.

Among the range of mental health issues for which people require treatment, depression is not uncommon. Many patients rely on their PCP for ongoing treatment and support.

While the typically brief appointments physicians are able to hold may be the greatest barrier to diagnosing the causes of the medical problem in an individual patient, “Fifty percent or more of those who receive care for depression receive all of their care from their primary care physician,” Korsen reports. In addition, “Privacy and the stigma of accepting the diagnosis become barriers to receiving care. There’s stigma even at the level of making the diagnosis. People tend to want a medical explanation for their symptoms and not a mental health explanation for their problems.”

The clinical model of depression care that Korsen advocates is based on the Chronic Care Model, which focuses on a team approach to healthcare, uniting physician, patient and resources for effective long-term care. “The time spent visiting with the physician is small compared to the time the patient is living and dealing with their condition. Self-management and self-care is a very important component of the Chronic Care Model. Motivated patients lead to more productive interactions.” Korsen stresses that redesigning and aligning a medical practice with the Chronic Care Model “is more than time-limited interactions between a physician and patient.” Enhancing access to information and access to agencies that provide care is crucial.

There is a link between mental and physical illness, Korsen says. “Many people who have chronic medical problems and diseases such as heart disease, cancer, and stroke, also experience depression. The assumption used to be that the depression was developed as a result of the chronic illness. But now, there’s research that shows the link may also be in the other direction. Some literature suggests that people who develop depression have an increased risk in later developing Type II Diabetes. There’s also literature that suggests if you have depression you’re more at risk for having a heart attack. If you’ve had a heart attack and you experience depression, you’re more at risk for developing a second heart attack.”

“One direction we are very interested in is forming partnerships between primary care clinicians and mental health clinicians for recognizing and treating mental health conditions,” Korsen says.

Dr. Bob Small, Director of Clinical Services at Spurwink, agrees that partnerships are key to delivering mental health care services. “At Spurwink, we work with individuals in both urban and rural areas,” Small said. “Unfortunately, rural areas frequently lack a wide range of mental health services. When mental health agencies and primary care physicians work together, we make it easier for rural families in Maine to access quality mental health care. In the process, we are adapting to their trusted and familiar health care setting as an integrated aspect of of their overall health care services.”

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