Tiffany came to see me as a new patient this week. She is a very nice young woman with a number of very big problems. She is a single mother to two daughters, one of whom is autistic. As a working mom, she has to juggle childcare and all the other household tasks. Her ex-husband is behind on child support and only rarely takes the girls for weekends. He has trouble managing their autistic child’s behaviors.
It probably won’t surprise you that Tiffany is REALLY stressed. She isn’t sleeping, and her anxiety is becoming harder to manage. She came in this week asking for a referral to a psychiatrist.
If you’ve been following me for a while, you probably know part of me started to do a quiet little happy dance on the inside as I was listening to my new friend. She was in the absolute perfect place because I have so many tools to help her. The one that I DON’T use often (and just sits dusty on the shelf almost all the time) is a psychiatry referral. I don’t need it except in rare cases.
It’s a good thing, too, because psychiatrists aren’t exactly thick on the ground in northern Ohio. In fact, most of the country has a severe mental health professional shortage.
Researchers found that this shortage is impacting how people get care for mental health problems in a big way. They looked at claims for mental health vs. physical health problems. The researchers found that people chose to go out of network and pay a larger share of the cost of treatment for their mental health problems.
While the researchers didn’t speak to patients directly and didn’t ask why they went out of network, it’s pretty obvious to me. Those of us in primary care know it takes months to get an appointment with a psychiatrist. Insurance companies often have only a handful of choices for in-network care, and many psychiatrists don’t take insurance at all because reimbursement is very low. If someone is severely sick or a danger to themselves or others, they are directed to the ER where they may be hospitalized. Otherwise they wait.
Here is my prescription for fixing our mental health care shortage:
- Every single person needs to have an established relationship with a primary care doctor. This means a family doctor, general internal medicine doctor (NOT A SPECIALIST) or pediatrician for little kids. If you are reading this and don’t have a primary doctor, GET ONE. See him or her annually for your physical at a minimum. If you don’t like your primary doctor, get a new one!
- Be aware of your lifestyle and its impact on your mood. Sleep, exercise, your spiritual practice, diet, ALL will impact your mood. Take small steps to improve your lifestyle before your mood starts to suffer!
- If you start to feel stress is getting to you, see your primary doctor before things get bad. Don’t wait until you’re so sick you can’t function at all!
- Consider seeing a counselor. Cognitive behavior therapy (CBT) is as effective as medication for mild-to-moderate depression and anxiety symptoms. It’s hard work, and requires a special kind of courage to unpack what’s going on in your life, but so worth it!
- Psychiatrists need to send patients with depression and anxiety who are improved and in remission BACK TO THEIR PRIMARY DOCTOR for management. There is no excuse for psychiatrists to continue seeing patients who don’t need them. This will free up space in their schedule for patients who are truly in need of specialty care.
So what did I do for Tiffany? First I asked her to make an appointment with a counselor. I also asked her to start some nutrition therapy with a good multivitamin, B complex and magnesium supplements. Because she was really struggling I started her also on a low dose of an antidepressant and a gentle non-habit-forming sleeping pill.
As food for thought, we discussed the recent research showing diet’s impact on depression and anxiety and I gave her some suggestions. We’ll continue to discuss this in the future. I’m sure when I see her back in a few weeks she will be feeling better and much more in control.
I can’t fix the things going on in Tiffany’s life that are difficult for her. Divorce, single motherhood, working motherhood, and a child with a chronic illness are real stressors. However, depression and anxiety make hard things just that much harder. Treatment is effective, and doesn’t require a visit to a psychiatrist.
QUESTION: Did you know there is a mental health professional shortage?