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Spokane, Washington  Est. May 19, 1883
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House call: Integration of behavioral health and primary care is beneficial

By Bob Riggs, MD For The Spokesman-Review

The medical community is becoming increasingly aware of the intimate connection between mental and physical health. Not taking care of one can lead to worsening in the other. The converse is also true: making the effort to promote good health in both areas can enhance a person’s overall well being.

I recently saw a fellow who came in for a number of medical concerns. I asked him to complete a questionnaire that asked about symptoms of depression, anxiety, and alcohol and substance use. As it was a busy day and I had concerns about some of his answers, I passed the questionnaire on to one of my behavioral medicine colleagues who was able to call him, talk about his stress, anxiety and depression. He appreciated the call as he was shy about bringing his feelings up. He was able to see a counselor, address his concerns, and after a few visits was feeling and coping better, and wasn’t as tempted to use alcohol to escape those feelings that he did not know how to handle so well before.

In a given year, one in four adults suffers from behavioral health concerns. Because of the link between mental and physical wellness, health care systems are moving to integrate primary care and behavioral health. As with other aspects of your health, the earlier a behavioral health concern is identified and treated, the better your outcome is likely to be. This means that if your primary healthcare provider has the tools to identify and treat behavioral health issues early, he or she can be your front line of defense.

Ideally, integrating behavioral health into primary care would include annual screening for mental health concerns and substance use disorders and the inclusion of a behavioral health consultant as a core member of the primary care team. Given that this is a new movement, there is significant variability of how much integration takes place across different practices.

The most important thing to know is that as behavioral health becomes more integrated with primary care, your healthcare provider or someone on his or her team may ask you some questions about how you are feeling mentally in addition to how you feel physically. Or there may be a new form to fill out when you arrive at the office. Questions may be general or quite specific. Whatever is the case, it may catch you off guard the first time it happens. Give yourself a minute to take a breath, relax, reflect, and really think about it. Then, tell the bald-faced truth, rather than the answer society has conditioned us to give when asked how we are (fine, and you?).

Whatever the truth is, and it may seem trivial to you, it is helpful information for your healthcare provider. For instance, if you have reported trouble sleeping on your last two or three office visits, it may be a pattern that is developing and needs to be addressed. Insufficient sleep does more than just make you tired. It can depress the immune system, lead to weight gain or loss, increase your blood pressure, aggravate heart disease, and make diabetes more difficult to manage.

Working with your primary care provider and his or her team to identify behavioral health concerns early can only work to your benefit. They are a team that knows you and can work with you to identify ways to approach behavioral health concerns that can work for you. Depending on your concern, the options you and your provider consider may be counseling, medication, or some combination of treatments. An integrated approach can result in better health outcomes for you, lower out-of-pocket costs, and improved interpersonal relationships.

It’s definitely a win-win-win for all of us.

Dr. Bob Riggs is a family medicine physician practicing at Kaiser Permanente’s Riverfront Medical Center. His column appears biweekly in The Spokesman-Review.

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