Addressing the Challenges of Medical Providers in Treating Persons with Mental Health Issues

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Training Summary

Our complex healthcare system means that there can be many different paths to treatment for mental and physical illnesses. General and family practitioners, internists, and for children, pediatricians, often are the first professionals we call when something is wrong with our health. We also may go to a clinic, emergency room, or head straight to a specialist’s office. There is no one-stop-shop for health care, and individuals often make their own decisions about where to get it.

When it comes to mental health, the role of a health care provider becomes even more critical. At least half and as much as 85 percent of the care for common mental disorders is delivered in general medical settings, not from a psychiatrist, psychologist or other mental health specialist.^{1, 2}

Fear of embarrassment is a factor when it comes to seeking help for mental health issues. Visiting a primary-care physician does not have the same fear as visiting a psychologist, says Eleanor Nelson-Wernick, PhD, clinical associate professor and co-director of behavioral sciences at University of Florida/North Broward Hospital District Family Practice Residency Program in Coral Springs, Florida.³ “Patients can tell the nurse they have a cold, but when the examination room door is closed, they can discuss and reveal things they may not feel comfortable with,” Nelson-Wernick says. “They may not even see it as a problem that a psychologist can help with.”⁴

The Building Bridges: Mental Health Consumers and Primary Health Care Representatives in Dialogue report, as well as other sources, notes several critical findings related to the healthcare of people with mental health problems.⁵ The high number of people who have a mental health problem and who seek help from physicians who do not specialize in mental health suggests that all doctors should be prepared to treat mental health issues, just as they’re prepared to treat physical health issues.⁶ Unfortunately, that’s not always the case. Mental disorders often go undiagnosed and untreated or undertreated in primary care.⁷ Also, physical disorders are sometimes overlooked when a person has a mental illness. Thirty-five percent of persons with serious mental disorders have at least one medical disorder that is not diagnosed.⁸

Primary care and other general physicians often are under-trained in the identification and treatment of mental disorders and may lack the knowledge, time, and resources to provide thorough care. And like many Americans, heath care professionals from all fields may possess negative attitudes towards mental illnesses, which can make it difficult to recognize and diagnose both mental and physical illnesses and provide the appropriate quality care.

Sources

^{1, 7} President’s New Freedom Commission on Mental Health. January 8, 2003. An Outline for the Draft Report of the Subcommittee on Mental Health Interface with General Medicine, www.mentalhealthcommission.gov/subcommittee/MHInterface_010803.doc, last referenced 6/6/08.

^2,3,4 Rabasca, L. April 4, 1999. More psychologists are building up their practices by partnering with primary-care physicians. APA Monitor Online. http://www.apa.org/monitor/apr99/doc.html, last referenced 6/6/08.

^{5, 6} Substance Abuse and Mental Health Services Administration’s Center for Mental Health Services. 2006. Building Bridges: Mental Health Consumers and Primary Health Care Representatives in Dialogue, last referenced 7/28/08.

⁸ Bazelon Center for Mental Health Law. (2004). Get it together: How to integrate physical and mental health care for people with serious mental disorders. Executive summary. Washington, DC: Bazelon Center for Mental Health Law. As quoted in SAMHSA’s Building Bridges: Mental Health Consumers and Primary Health Care Representatives in Dialogue last referenced 7/28/08.

This training will:

• Describe what research shows about 1.) the challenges providers face in providing general and mental health care to persons with mental health problems; and 2.) the challenges, including attitudinal barriers, persons with mental health problems face when attempting to get quality mental and general health care from providers who do not specialize in mental health.
• Offer first-hand accounts from individuals about their health care experiences with health care providers—both of what worked and what didn’t work.
• Provide an overview of strategies that may help providers to develop accepting, recovery-focused attitudes that help to improve the diagnosis and care of persons with mental health problems.

Presenters

Anthony T. Ng, MD
Dr. Ng is an Assistant Professor of Psychiatry at the Uniformed Services University of Health Sciences and the George Washington University School of Medicine.  He is a board-certified psychiatrist and a director of Mannanin Healthcare, LLC, a health care consulting firm and a medical officer with the DC Department of Mental Health Comprehensive Psychiatric Emergency Program (CPEP).He is the current President of the American Association of Emergency Psychiatry as well as being a member of the boards of the American Association of Community Psychiatrists and Mental Health America.  He has a lengthy history of involvement and advocacy in community mental health issues and extensive experience in the area of primary care and mental health, cross cultural issues, community system issues, substance abuse and homeless issues.  He is also involved in community mental health and disaster mental health. 

Dally Sanchez
Ms. Sanchez is currently the coordinator of YOUTH POWER! the statewide youth network of Families Together in New York State. She is a 27 year-old, Latina suicide and trauma survivor who has been an advocate for 12 years. Formerly from Westchester County, NY Youth Forum, Ms. Sanchez began her career in this group as a member, and then became a peer leader and eventually co-coordinator and office manager for the group. She also has been a part of the national and statewide youth movement for the last ten years. Ms. Sanchez attended and participated in the 2001 SAMHSA Systems of Care community planning meeting and the 17th Annual Rosalynn Carter symposium on children’s mental health. She is a member of the New York Association for Psychiatric Rehabilitation Services Board of Directors as Co-chair of the Cultural Competency Committee, the New York State Multicultural Advisory Committee to the Commissioner of the Office of Mental Health and the New York State Recipient Advisory committee to the Commissioner of the State Office of Mental Health. Ms.Sanchez also serves on the ADS Center Steering Committee.

Benjamin G. Druss, M.D., M.P.H.           
As the first Rosalynn Carter Chair in Mental Health at Emory University, Dr. Druss is working to build linkages between mental health and broader public health and health policy communities. Dr. Druss has published more than 100 peer-reviewed articles largely focusing on the policy and systems issues on the interface between primary care and mental health.  He has received several national awards for his work, including the 2000 American Psychiatric Association Early Career Health Services Research Award, the 2000 AcademyHealth Article-of-the-Year Award, and the AcademyHealth 2003 Alice S. Hersh New Investigator Award.  In 2006, was the recipient of a five-year Career Award from the National Institute of Mental Health titled “Mending the Public Safety Net: Improving Linkages Between CHCs and CMHCs.”

Presentations

Presentation materials for this event are available below in two file formats: PPT (MS PowerPoint) and PDF (Portable Document Format).

Teleconference Presentation [PDF Format - 2 Mb]
Teleconference Presentation [PowerPoint Format - 2 Mb]

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