Primary care is where people go when they have symptoms of an unknown illness or for an annual physical. Providers in Bloomington-Normal want to make sure people know their main doctor can also provide mental health support.
As Stephen Hill, a family medicine doctor at the Carle BroMenn Outpatient Center in Bloomington, puts it, primary care is a person’s “first line of defense” regarding health. They can treat anything, from chronic conditions to the common cold and even mental illness.
“We actually do treat quite a bit of anxiety and depression and address those concerns with our patients,” Hill said. “It’s actually something that is a quality of care measure for us.”
It’s a mixed bag whether people know their primary care is available for mental health struggles, Hill said. Some people are really knowledgeable and may schedule an appointment for that purpose. Others have no idea it’s something a primary care doctor can address.
While it tends to be forgotten, OSF HealthCare primary care physician Mfowethu Langeni said, “health includes both physical and mental.” He pointed out that primary care doctors are trained in everything, and an annual check-up is just one example.
“We do blood pressure, we do weights, we'll do vitals, but also part of the screening is something called depression and anxiety screening,” he said.
If a patient raises a mental health concern or the questionnaire flags anything, Langeni said primary care physicians [PCPs] can handle it accordingly.
“I feel pretty comfortable, and most colleagues will probably agree, managing our basic and most common mental health issues,” he said.
That includes clinical depression, anxiety, bipolar disorder, dementia, attention deficit and hyperactivity disorder, schizophrenia, obsessive-compulsive disorder and post-traumatic stress disorder, Langeni said.
“We've been trained to identify some of these things, we've been trained to help navigate resources,” he said. “Most times, actually, in that appointment, we can even talk about starting medication.”
Chestnut Health Systems Chief Clinical Officer Matt Mollenhauer said he considers PCPs to be “a big part of the equation” in getting people prompt care.
“We know we have a shortage of psychiatric care, for example, in this community, and so creating the capacity for more people to get behavioral health happens because primary care can play a role in this,” he said.
Chestnut is also a somewhat unique provider for that area in that it started with behavioral health care, focused on both mental health and substance use. Primary care became an offering later, but Mollenhauer said that allowed the nonprofit to be more intentional about its construction. Now, Chestnut has its mental health and primary care under one roof.
“It's the dynamic where if I as a medical provider, am seeing a patient and I identify as a mental health issue, I can walk that person next door to do a quick assessment or a screening,” he said.
While Chestnut and OSF do not have the same set-up for offices, Hill and Langeni said their roles still collaborate often with mental health specialists. They said they go to their more specialized colleagues for occasional advice.
Doctors at any of these facilities can also refer to specialists when a diagnosis feels out of their wheelhouse. Even when that happens, the primary care provider will often still manage care alongside the psychiatrist, tweaking prescriptions and reassessing mental wellness.
OSF has specific resource navigators to help people connect to the right mental health outlets. Megan Demos is one of these behavioral health navigators. She pointed out that properly treating someone’s mental health requires collaborative care.
“The care for the patient's mental health doesn't stop the minute you put in that referral,” she said.
With sometimes high wait times due to the workforce shortage, Demos added that part of the navigator's job is to keep the PCP in the loop.
“To still help manage the symptoms that person is having,” she said.
Carle psychiatrist Rachel Immen said she leans on her client’s main doctor for assistance. In particular, initiating mental health conversations.
“The primary care provider often can start the conversation with already a lot of trust established, and that's an absolute necessity when someone is seeking out mental health care,” she said.
Both Immen and Mollenhauer spoke of a symbiosis that occurs between the PCP and the psychiatrist. They said sometimes it can be helpful to transition a client from psychiatric care back to primary care once their mental health is improving. Immen said she calls this a graduation of sorts.
“It is extremely helpful for the patient, because they are more frequently in contact with their primary care office,” she said. “They can wrap this up into fewer appointments. They may have better access to primary care because they don’t have to travel or the hours are different, and they again, have that sense of their primary care provider knows them well.”
On the flip side, Immen said some patients will only want to receive specialized treatment from a mental health professional for those same reasons. Some people are also wary of medical treatment in general, she said, adding that it is okay — as long as they seek help.
Mollenhauer also lamented that more people don’t raise substance use issues with their PCP and that the doctors themselves don’t necessarily always ask about it. He said he thinks part of the issue is the label, which he thinks could be thrown out altogether. He jokingly recommended it be called “purple elephant” if that means more people will discuss it openly.
“The reality is, is that we should be looking at the whole person,” he said. “Whether we put a label on it, as a family medicine issue, a behavioral health issue, a substance abuse issue, be, you know, whatever. I don't think it matters. It comes down to the patient's relationship with the provider and the comfort in addressing anything.”
Mollenhauer said he hopes that both patients and providers can better understand the system so that it works in favor of someone’s health.
“Let’s call it a purple elephant and just help the person,” he said.
