Research Highlights Primary Care’s Role in Mental Health. They are recommending greater support for primary care for mental health.
This falls under "no shit, Sherlock" for me.
“Primary care physicians provided most of the care for depression, anxiety and AMI (any mental illness),” its authors conclude. “Almost a third of the care for SMI (severe persistent mental illness) and a quarter of the SMI prescriptions occurred in primary care settings. Our study underscores the importance of supporting access to primary care given primary care physicians’ critical role in combating the COVID-19 related rise in mental health burden.”
Well, yeah. We have no choice. Our rural county has 30,000 people and three psychiatrists total. One is owned by the hospital and as an "outside" physician, I was not allowed to refer to her. One works half time in another state psychiatric hospital, flying back and forth, takes cash and not insurance, and didn't call me back about a patient in crisis about 8 years ago. A mutual patient. On the phone later he said, "I didn't think it was important." Hoo-yeah, honey, that was the last referral you got from me. The third one is a friend and independent. We sent people back and forth like yo-yos until my clinic closed in January.
Also, we essentially have one mental health office that takes medicaid, medicare and other insurance. Many of the counselors in town are cash only or they take some insurance but not all and it changes. The counselors range from people with a masters to social workers to PhDs. I don't care about the degree. With the ones who've been around, I know who I think is good. I have ones that I send the children to, there are a couple, praise the Beloved.
Back in 2009 when the hospital kicked me out of their clinic, I called back a month later. "Has anyone seen X?" I asked. They checked. "No." "Find him and get him in. He needs his haldol shot." Monthly. This guy lives alone in the woods. Schizophrenia. At one point he was losing weight and I bugged him. He admitted he was only eating once a day. He said that voices were not too bad. Mostly. I nagged him to go to community meals. "Make sure someone sees him. He doesn't trust anyone."
Our mental health office rather fell apart a couple years ago and we all got phone calls. "You need to take over the psychiatric medicines for these patients." Crap. Schizophrenics, people with bad bipolar disorder, people who are manic. I don't mind taking over the medicines, though some are ones I've never prescribed. The worry is that if the person gets unstable, I am not comfortable adjusting their medicines. I hate benzodiazepines especially. Antipsychotics also suck, since the number of patients who say they are on them "for sleep" is well, all of them. No, not my in the woods schizophrenic. He knows he is on them for the voices. The problem from my perspective is that the antipsychotic gets added on for treatment resistant depression or for mood stabilization but the mental health people are NOT in the habit of telling patients what their diagnosis is. Often the mental health provider doesn't want to commit, so to speak. Getting notes has an extra Hipaa layer. And the notes often don't really SAY much. Well, and that's because we make up all the words. Your diagnosis with DSM IV may have not even exist in the DSM V. Is it feeling a little bit fuzzy yet? It is WAY FUZZIER THAN I AM COMFORTABLE WITH. Especially since my last four psychiatrists have said: you have A. No, I don't believe in A, it's B. Third one just didn't say much. Fourth one is back to B and hasn't read the guidelines on A. Why would I trust her since she hasn't read about A? Holy cats. It's ridiculous. Someone asked me today why I don't go to a Washington State expert in Adult PANS. Unfortunately I may BE that expert, which is difficult and ridiculous. I contacted the Infectious Disease doctor who first told me about PANDAS in 2012 and he said he doesn't know of anyone in the state. He is the Washington State Health Department acting director of Communicable Disease, so he might be a little preoccupied with Covid-19 right now. But, if HE doesn't know of anyone.... he says try the University of Washington.
Ok, back to Covid-19. NY Times today says that 20% of the cases are now children and we are over 100,000 cases a day and there are cases of long covid in children. Um. If a school is not masking.... well. I am glad I don't have small kids. I do have a daughter who is gearing up to teach eighth graders. Great. Talk about exposed.
My primary care doctor was gloved and gowned and masked when I saw her last week for my ER follow up. I blinked. I was scheduled to see her partner. She explained that a young man had said no to all the front desk questions about covid-19 and then in the room, told her that he had no sense of smell, was short of breath and by the way, unimmunized and his girlfriend and father, 51, are unimmunized and sick. Great. So they closed that room off, juggled the schedule, gowned and gloved for the rest of the day and she is quarantining at home from her own son and husband. How nice of the young man. I could brain him.
And we do have the delta variant here and in the county north of us, 15 cases in a week.
Be careful out there. I, personally, am staying in.
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What percentage of the US population gets psychosis? https://www.therecoveryvillage.com/mental-health/psychosis/psychosis-statistics/
What percentage of the US population is taking an antipsychotic? https://pubmed.ncbi.nlm.nih.gov/26528641/ Antipsychotics are on the Beers Criteria list, that is, should only be used with great care and caution in people over 65.
What percentage of the US population is on a behavioral health presciption? https://www.scientificamerican.com/article/1-in-6-americans-takes-a-psychiatric-drug/