Your primary care doctor can help you with mental health challenges, too

As we were finishing up his quarterly office visit for management of diabetes, I turned toward my patient, sat quietly for a moment, and then asked, “Is there any other concern that you were hoping we could talk about?”

I try to ask this as a matter of routine, but on this occasion, his mood seemed a little flat. Most of the time, there’s nothing further patients want to discuss, but occasionally, like on that day, there’s something important they want to talk about and need the extra encouragement to share.

“Only if there is time,” he said reluctantly, and I assured him there was.

He told me he felt sad most days and was struggling to get out of bed in the morning. He was hesitant to bring it up, he said, because he didn’t think primary care doctors addressed these sorts of concerns.

Primary care clinicians are, in fact, very interested in and well-trained to treat patients who suffer with anxiety and depression. And for good reason: Mental health problems like depression and anxiety are common and affect other aspects of health. Up to 75% of all primary care visits include some discussion of a mental health concern, and it is often the most important health issue we cover during a visit.

At the same time, trying to access mental health care directly can be very challenging — insurance coverage is irregular with limited participating providers, many of whom are not accepting new patients.

» READ MORE: If you’re struggling with depression, here’s how to get help.

If you’re feeling overwhelmed with how to get help, your primary care doctor is a great place to start. In recent years, health systems across the country, including here in Philadelphia, have been integrating mental health care with primary care. Many of our primary care practices have in-house psychologists, psychiatrists, and social workers.

When needed, patients can be seen quickly by an intake counselor and referred for the appropriate level of follow-up care. This integrated care model has been shown to improve depression symptoms, as well as patient and clinician experience of care.

You may even find that depression screening questions are now part of the intake process at many of your office visits, another part of our effort to prioritize mental health and identify patients who are at risk. If you are feeling sad, worried, or stressed, you are not alone. Don’t assume it is just something you should be able to “handle,” or, like my patient, that you have to find a mental health specialist on your own.

And it doesn’t have to be tagged on at the end of a visit, something to address “only if there is time.” Lead with it — in the eyes of your primary care team, nothing outranks your emotional health.

» READ MORE: Opinion: I’m a veteran. Getting help with my mental health changed my life.

After talking to my patient for a few more minutes, I felt comfortable that he was not at risk for self-harm, but was clearly suffering from depression. I prescribed medication and referred him for counseling.

When I saw him again, he said he was doing better, thanked me for my help, and remarked on how asking for emotional help made him feel weak. I reminded him that if there is anything talking about depression is a sign of, it is strength and courage.

Jeffrey Millstein is an internist and regional medical director for Penn Primary Care.