Don't be surprised if your primary care physician asks about your mental health

Sometimes the first step is the hardest.

It may be dying hair green to attract someone's interest on the first day of fifth grade. It is the toddler aiming to precariously waddle across the living room. It is taking a mental health screening.

“The screening process is currently underutilized and could be a much more powerful tool in the field of mental health,” said Derek Lee, CEO of Perrysburg Counseling Services. “It's important, and if we ever want to move towards preventative mental health, as we've done in dentistry, screenings are a necessity.”

From the perspective of Mr. Lee, a certified suicidologist, mental health screenings are an effective tool.

“What typically makes them ineffective are the systems in which they are used or the manner in which they are administered,” he said. “Many are being rushed through by allied professionals as a billable add-on, being forced to do one more thing in an already difficult system.

“I say that carefully as I love and respect those allied providers; I also know that they are struggling to provide a high level of care in the modern market of industrialized medicine,” he said. “If the screening were being channeled through trained mental health professionals, it is likely that we would have more accurate outcomes.”

Mental health screening materials run from free to a few dollars to megabucks. They can even be licensed for an annual fee. In terms of revenue, the global market, estimated at $900 million in 2023, is poised to hit as much as $1.8 billion by 2029, according to a report by MarketsandMarkets.com.

Regionally, ProMedica and Mercy Health physicians screen adult patients annually.

“We have a questionnaire for everything,” said Dr. Holly Dickman, a primary care physician with Mercy Health, adding she has been treating a significant number of patients for anxiety and depression. “In 2020, everyone was isolated and that was causing a lot of depression. ... Mental health is more on everybody's mind.”

Screening questionnaires have guidelines to follow, depending upon the patient's answers.

“For example, if someone screens positive for suicidal thoughts, the next step is that they are monitored immediately by a professional, and we have to complete a different and more comprehensive suicide risk assessment, like the Columbia suicide severity rating scale,” said Dr. Victoria Kelly, vice chair for education in the Department of Psychiatry at the University of Toledo.

While a mental health screening is the first step, finding services is another.

“There is a significant waiting list in northwest Ohio for most mental health providers,” Dr. Dickman said.

A patient may require hospitalization. In other scenarios, medication or adjustments to it may be provided on an outpatient basis.

“Another example is when you take your 18 month old in for a well-check,” said Dr. Kelly, who will be serving a second term as president of the Ohio Psychiatric Physicians Association next year.  “They'll receive a screening questionnaire about autism, which is very important because early detection and then early interventions can significantly improve the quality of life and attainment of milestones. Screening can absolutely save lives.”

Screening tools do not offer a one-size-fits-all diagnosis, according to Dr. Brian Miller, vice president of medical operations for ProMedica Physicians Group.

“In any primary care visit, 70 percent of the time a behavioral health issue comes in during that visit,” Dr. Miller said. “We pretty much get to everybody each year .... Then the work begins.”

ProMedica's primary providers are able to help most of the patients, who also can be referred to a specialist, including therapists, counselors, and psychologists. A peer navigation team is available to make sure those connections happen.

“It is really about identifying and tailoring our treatment,” said Dr. Miller, pointing to telehealth as an important aspect to accessing therapies. “The specialty that uses telehealth most is behavioral health.”

In addition to a navigation team, ProMedica has imbedded licensed social workers in some physician offices in under-served areas where mental health issues, especially among children and teens, can be complex and more difficult to ascertain.

“It is a small and specific thing,” Dr. Miller said. “It makes you proud of the system.”

Reducing stigma

While still stigmatized, there has been more acceptance of mental health disorders, especially among a generation whose lives are openly displayed on social media, where gray matter may be excruciatingly examined.

“The people in their 20s are the ones who have a lot of knowledge about mental health issues and they do not seem to have any problem talking about mental health,” said Marianne Huff, president and CEO of the Mental Health Association in Michigan. “They grew up in the age of the Internet. I think that has a lot to do with it.”

Mental health practices have changed significantly since the pandemic, according to Dr. Kelly.

“Telehealth has been the silver lining to COVID. Telehealth allows us to meet the patient where they are and increases access to care, which is also convenient,” she said. “Thankfully, the federal and Ohio governments have recognized this and allowed it to continue past the emergency declarations.”

Ohio is seeking to expand its Mobile Response Stabilization Services for those up to age 21 to every county in the state. Youth can receive assistance within 60 minutes and may get up to 42 days of intensive, in-home services with links to ongoing support. The Ohio Department of Mental Health & Addiction Services will be allocating as much as $12 million to eligible providers.

Nationwide Children's also is aiming to fill in the gaps in mental health services for young people.

As part of its Zero Suicide initiative, patients discharged from the hospital can enroll in Caring Contacts, which are validating messages sent via text messages, postcards, or letters offering ongoing care and support without placing any demands – such as a reminder for the next appointment.

“Prior research has shown that patients are around 300 times more at risk of suicide in the first week after hospital discharge, and 200 times more at risk over the first month compared to the general population,” said John Ackerman, a child clinical psychologist at Nationwide Children's Hospital in Franklin County. “Reaching patients where they are in their day-to-day lives is crucial in supporting them before, during, and after a crisis. That also means ensuring messages of hope and validation are accessible with the technology they use most – their phones.”