Addressing the Shortage of Mental Health Professionals in Primary Care
In this interview, Julie Frey of Wolters Kluwer Health discusses the importance of integrating mental health into primary care, the barriers faced by providers, the long-term costs of untreated mental health conditions, and successful strategies for fostering collaboration and empathy in developing treatment plans.
Julie Frey: My name is Julie Frey. I'm vice president of Product at Wolters Kluwer Health. I'm primarily focused on an existing set of products that we offer to the provider market and a lot of the innovation that we're working on in that space. In terms of my background, I have worked in health care strategy and product strategy for health care for more than a decade. I've primarily been focused on the US or North American markets, but I also had some experience in that space abroad. Looking ahead, one of the big things that all the product teams are focused on is the opportunity with artificial intelligence (AI). In terms of innovation themes, that's very much where everyone is looking right now. All this together indicates that a considerable number of patients need support.
Why is further integrating mental health into primary care an essential collective goal?
Frey: It's a huge part of what we've been focusing on recently. I think some of the stats speak for themselves. The data that we have suggests that almost a quarter of adults in the US live with some type of mental illness. For many of them, little specialized care is available in their area. The number of patients with mental health illness has grown recently. I think the pandemic was part of that, but I also think it's due in part to the decreased stigma, and patients feel more comfortable talking about mental health. You've got more folks willing to come up and talk about some of the challenges they're facing and looking for help.
Primary care is one of the major user groups and markets for us. We have many customers who are primary care providers (PCPs), and we spend a lot of time talking to them and listening to their needs and priorities. We found that around 40% of patients who see a PCP have some kind of mental health concern, numbers even higher than at the population level. Also, about 80% of antidepressant prescriptions are coming from PCPs. Historically, primary care physicians were not the folks who were on the front line of mental health treatment. Instead, patients would be referred to a specialist. Now more than ever, we have a shortage of mental health professionals. We have high numbers of patients with needs around mental health, and PCPs are inundated.
What are some of these key barriers that arise due to shortages of mental health professionals and limited training in mental health among these PCPs?
Frey: It's been fascinating. We've spoken to many health care leaders and our end users on the ground with PCPs. Health care leaders are very aware of these challenges for PCPs. They're focused on hiring more specialists; and encouraging PCPs to refer patients. However, I think the reality is that none of those things will solve the problem in the short term because, ultimately, PCPs want to take care of their patients, but there just aren't enough specialists. If a PCP refers a patient to a specialist, the patient must often wait months and months to be seen. It's not a sustainable short-term solution.
I think there are a couple of things that are also unique beyond the ongoing pressure on PCPs that make this an important problem to solve. One of them is that a diagnosis in this space is quite subjective. I always use the example that you have a very sore throat and go to a PCP, they can run a strep test. The strep test will come back with the result. Either you have strep throat, or you don't, it's done. And then, you follow the diagnosis path and the treatment path. However, mental health is a much more subjective or amorphous area. Are you depressed? Do you have anxiety? To what extent should one medicate? These are much more difficult decisions that take more time. This is a particularly challenging set of diseases for PCPs to deal with.
According to the data, PCPs probably only spend 15 to 20 minutes with each patient. Many of these patients have a host of conditions. They may not be struggling just with their mental health; they often have a chronic condition, too. All these barriers and challenges work together to make treatment more complicated.
What are some of the long-term costs of untreated mental health conditions for both these patients and providers?
Frey: More research is coming out about this. In general, having untreated mental illness is a huge challenge in and of itself. Then factor in that about 50% of patients who have a mental health disorder also have a chronic medical condition. Some of the evidence shows that if a patient is not able to manage a mental health illness, they may also struggle to manage other chronic conditions such as diabetes or obesity or to adhere to prescribed medication. If mental health isn’t treated, the PCP is much less able to treat all the other conditions that typically the patient faces that the PCP generally is more confident in treating.
When we think about the health system broadly and the cost to society, primary care patients with major depression have 50-to-100% greater medical costs. You're not just dealing with multiple unchecked conditions; you're also dealing with increased system costs. There are multiple layers of mandate to try and figure out how we can help PCPs and patients better manage care around mental health.
Please share any successful strategies you found to foster collaboration, empathy, and inclusion while developing mental health treatment plans.
Frey: Ultimately, we must work through the health care ecosystem, from regulation to the health systems, to health care leaders, clinicians, patients, and beyond. One angle is clinicians. We need more folks who are specialists in mental health and the treatment of mental health conditions. That's the only sustainable, long-term answer. But we also must be realistic; this is not a short-term effect. Folks, of course, must take the time to complete medical school.
The next best strategy on the clinician side of the problem is empowering PCPs as best we can. And there's a whole host of education and tools to help PCPs. Empowering PCPs so that they feel more confident is also a goal. How do you have these difficult conversations with your patients? What are the most effective treatments? How do you use the evidence to help them? It is important to guide PCPs and empower them so they can practice at the top of their license as much as they're comfortable diagnosing and treating common, less complex mental health illnesses like depression and anxiety.
Another consideration is empathy. PCPs need to know how to make patients feel comfortable having conversations about mental health. How can we guide and train PCPs to speak with empathy and kindness, and support a patient to be vulnerable about their mental health?
Engaging the patient will not work unless we focus on patient-centered care teams that are patient-centric. We’re also looking at building out several tools to support the decision-making around prescribing medications. For depression or anxiety, there are a host of medications that the evidence suggests are all equally effective. However, there is also a host of other factors that we want to communicate effectively to the patient, such as the fact that some medications must be taken more frequently. Some medications may take longer to have an impact, etc. There are all kinds of secondary effects to consider. Patients must be asked how realistic it is with their lifestyle to take a pill multiple times a day or to deal with certain side effects. At the end of the day, it is about having engaged and empowered patients, which will improve adherence and make treatment more effective. We spend a lot of time speaking to PCPs, patients, and therapists about patient-centered care teams or collaborative care team models. This centers on patients, the PCPs handling medication and selection, and the therapists providing ongoing care.
The last thing about this is simple yet so important. You have to have voices and visuals that resonate with patients when you provide information and education, whether it's a leaflet, a video, a tool, or something to help them better understand and manage their mental illness. When patients are considered, they are much more likely to be effective and engaged. If we want patients to be on board, empowered, and educated, they need stakeholders that understand them and care about them as individuals, not just as a statistic. If patients only have 15 minutes with a PCP, we need to make all other interactions and touchpoints through technology feel personal.
Are there any other key messages you'd like our audience to walk away with?
Frey: Speaking to health care leaders, the opportunity with generative AI (GenAI) is really promising. There are many opportunities, specifically around mental health, that we, as a vendor to this landscape, are evaluating. However, I would also encourage providers to do their research. There's a chance to expand access, improve the balance between demand and supply, and help clinicians save time on administrative things. Interesting ambient technologies and AI are coming out where instead of staring at a screen and typing, clinicians can be focused on the patient while technologies handle administrative tasks. GenAI may encourage evidence-based decision-making.
The second thing is that in conversations with health system leaders, they seem eager to focus on building their network of referrals or directly hiring more specialists. I wouldn't discourage this strategy, but they may underestimate the reality that PCPs will be on the front line for a while. The strategies they're focused on are longer-term solutions. We should also focus on how we can acknowledge the burden PCPs are facing and how to support them through innovative training and collaborative care models. We can't just pretend that at some point we're going to be able to hire enough specialists to match demand. Since things are going to stay the same in the short term, we need to continue finding new ways to support PCPs.
