By Julie Radico PsyD ABPP

The National Center for Health Workforce Analysis projected that by 2025 there will be a 45,000 or 250,000 shortage in mental health professionals. This includes a projected shortage of psychologists between 8,220 to 57,490.1 Collaborative care models for primary care, including integrated and colocated models, can reduce costs and improve clinical outcomes for patients with mental illness and chronic health conditions.2 When psychologists work closely with primary care providers through an integrated care model, barriers that limit access to care are reduced.

 

Psychologists are well equipped to meet the treatment needs of patients presenting to primary care, including anxiety and depression. For example, psychological treatments for anxiety are efficacious in primary care and are more effective when provided by a specialist (psychologist or clinical psychologist) than a non-specialist (PCP, nurse, trainee).4 Furthermore, treatment for depression should follow a stepped care approach in which treatment is guided by the severity of depression, requiring active monitoring of symptoms and functioning, and psychologists can play an active role at all levels of such treatment.5 High intensity psychological interventions with effectiveness for anxiety and depression include cognitive behavioral therapy, problem solving therapy, and interpersonal therapy.5-6

In an integrated model, physicians are allies in reducing barriers to patient engagement in behavioral health care, by emphasizing how mental health is related to physical health concerns and instilling hope, by noting that additional treatment can help.7 Psychologists can enhance collaboration in primary care settings by utilizing the GATHER model, by being a Generalist, being Accessible, approaching care in a Team-based way, being Highly productive, Educating patients about health issues and coaching the medical team, and become part of the Routine clinic work flow.8-10 Overall, the collaboration of PCPs and psychologists can positively impact patient care in several ways and is encouraged as an approach to treatment, especially considering potential workforce shortages.

 

  1. US Department of Health and Human Services. (2016). National projections of supply and demand for selected behavioral health practitioners: 2013–2025. Rockville, Maryland. Retreived from: https://bhw. hrsa. gov/sites/default/files/bhw/healthworkforce-analysis/research/projections/behavioral-health2013-2025. pdf.
  2. Firth, J., Siddiqi, N., Koyanagi, A., Siskind, D., Rosenbaum, S., Galletly, C., … & Stubbs, B. (2019). The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. The Lancet Psychiatry, 6(8), 675-712.
  3. Colorafi, K., Vanselow, J., & Nelson, T. (2017). Treating anxiety and depression in primary care: reducing barriers to access. Family practice management, 24(4), 11-16.
  4. Parker, E. L., Banfield, M., Fassnacht, D. B., Hatfield, T., & Kyrios, M. (2021). Contemporary treatment of anxiety in primary care: a systematic review and meta-analysis of outcomes in countries with universal healthcare. BMC family practice, 22(1), 1-15.
  5. Ramanuj, P., Ferenchick, E. K., & Pincus, H. A. (2019). Depression in primary care: part 2—management. BMJ, 365.
  6. Andrews, G., Bell, C., Boyce, P., Gale, C., Lampe, L., Marwat, O., … & Wilkins, G. (2018). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. Australian & New Zealand Journal of Psychiatry, 52(12), 1109-1172.
  7. Sherman, M. D., Miller, L. W., Keuler, M., Trump, L., & Mandrich, M. (2017). Managing behavioral health issues in primary care: Six five-minute tools. Family practice management, 24(2), 30-35.
  8. Schrager, S. B. (2021). Integrating Behavioral Health Into Primary Care. Family Practice Management, 28(3), 3-4.
  9. Reiter, J. T., Dobmeyer, A. C., & Hunter, C. L. (2018). The primary care behavioral health (PCBH) model: An overview and operational definition. Journal of clinical psychology in medical settings, 25(2), 109-126.
  10. Robinson, P. J., & Reiter, J. T. (2016). Behavioral consultation and primary care: A guide to integrating services (2nd ed.). Geneva: Springer