Conditions like depression, anxiety and substance abuse in young adults are getting more attention than ever after the traumas of living through a pandemic and coping with political and climate instability.
Many logically assume the first step is to find a therapist or psychiatrist, which can lead to time spent on online research and phone calls to find someone in-network with your health insurance, followed by multiple weeks or months of waiting for that first appointment.
What you might not think to do is save that time and energy by starting with a simple visit to your primary care team.
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“We talk about mental health all the time,” said Dr. Pulak Patel, a family medicine physician at Novant Health Primary Care South End in Charlotte, who has seen an uptick in mental health symptoms at her clinic. “Sometimes I feel like we’re primary care psychiatrists. We’re kind of the quarterbacks of a patient’s health. We’re trying to initially evaluate, assess and manage everything that we can.”
Primary care physicians are equipped to manage a lot of concerns beyond physical health. They include a variety of mental health conditions, including anxiety, depression, postpartum depression, post-traumatic stress disorder and panic attacks. (Note, you’ll see the phrase “behavioral health” used to refer to mental health in many health care circles.)
Patel also has a nonoperative sports medicine background, so she commonly treats sprains, strains and arthritis, and she can administer injections for orthopedic conditions. Bonus: She speaks both English and Spanish to reach more patients.
“In general, what I love about family medicine is the variety of patients and illnesses we get to see,” she said.
Patel explains what young adults should know about their primary care physician’s variety of capabilities when they’re concerned about their mental health.
If you’re having symptoms, your primary care physician can assess you.
If you have a serious concern like bipolar disorder or schizophrenia, we can refer you to the right psychiatrist. But with more common concerns like stress, it’s similar to having high blood pressure – you don’t necessarily need to see a cardiologist right away.
We screen everyone for depression and anxiety. When people come for their first visit or for their annual physical, I have them do a questionnaire online or in the office. Depression is a nine-question screening based on symptoms, and anxiety is a seven-question survey. If either screening is positive (indicating depression or anxiety), we can talk about it further.
A lot of people are willing to talk about but don’t know how to bring it up or don’t know it’s something we can talk about. I can ask them how long they’ve been feeling this way, and it opens the door to a deeper discussion.
Top scores for safety in NC
Novant Health just received the most ‘As’ for patient safety in North Carolina from The Leapfrog Group. With a focus on safety, quality and patient experience, the national, industry-leading nonprofit, evaluates and assigns letter grades ranging from A to F to hospitals across the country. Novant Health’s hospitals with “A” grades outperform 70% of hospitals nationwide for safety and quality.
Your primary care physician can give you options for addressing your concerns, including medications and lifestyle changes.
In primary care, we try to do shared decision-making. I work with patients to best treat their conditions in a way that they think may be beneficial. If they have severe symptoms, I might recommend medication and therapy.
If they have mild symptoms of anxiety, I might suggest therapy to help address stressors and to learn ways to cope with stressors. But we can also set some goals – like taking five minutes every morning to meditate or to journal. Regardless of the choice, that patient can check in as frequently as necessary and we can reconsider the approach as needed. But I want people to make the decision with a knowledge base behind them.
You can set up telemedicine appointments to talk about certain mental health concerns.
I do get messages sent to me, patients I’ve only seen for an annual visit who say they’ve had symptoms of anxiety, who ask if I can put in a referral. I tell them yes, but I’m also happy to schedule a visit specifically so they can come and see me for this.
We’ve really embraced the telemedicine aspect of it so especially for things like depression and anxiety where I don’t need to listen to their lungs or see them in person, we can do a virtual chat. During this call, we can start to assess their concerns. This cuts down the wait time. I don’t want people who are feeling anxiety or depression to wait for three months for an appointment with a psychiatrist. Let’s get started on something that’s helpful. The easiest way to get the ball rolling is using your MyChart app to schedule an appointment.
If you’re already on medication through a psychiatrist, you can start getting that prescription through your PCP.
If a patient has been on certain medications for a long time and is stable, I’m happy to take over and manage the prescription. To do that, records are always helpful to have such as evaluations or diagnostic work. Also, If I’m going to manage a condition that has been treated in the past by a psychiatrist, I’ll do it in my way as well, starting with an assessment and review of previous treatments. We can even start from scratch, like if someone used to be on multiple medications and is no longer on them, or if they want to reduce their number of medications.
Bottom line: If you’re experiencing mental health concerns, you can send a message to your primary care provider or talk to them about it during a routine appointment.
Anxiety and depression are super common, but we’re not going to know about it unless we ask about it or patients bring it up to us. We’re working to make this conversation more approachable by normalizing it.
