Treating the whole person includes mental health care

A message to all physicians from AMA President Jeremy A. Lazarus, MD.

By Jeremy A. Lazarus, MD, a Denver psychiatrist and immediate past president of the AMA. Posted Oct. 29, 2012.

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One of my personal goals as president of the American Medical Association is to work toward better integration of mental health and mental illness into the rest of medical care.

The time is ripe. Health care reform is about making sure that everyone who needs it has access to whatever kind of health care he or she needs — including mental health care. Here are some examples and opportunities:

  • The Affordable Care Act includes a provision that brings coverage for depression and other mental health disorders into the modern age.
  • Depression is also a higher priority for Medicare, which now pays physicians for the early detection of this common illness. Medicare payment for mental health treatment, which for decades placed a higher out-of-pocket burden on patients treated for depression than treatment for physical disorders, is now on par with the program’s other areas of coverage. Starting last Jan. 1, the program now also covers preventive screenings for depression and, in a separate policy proposal, alcohol misuse.
  • The new emphasis on medical teams that deal with all aspects of a person’s care offers an opportunity to include psychiatrists and other mental health professionals in those teams.

A good example of this is the DIAMOND Initiative organized by the Institute for Clinical Systems Improvement in Minnesota. There, psychiatrists are being paid for consulting with primary care practices on the best way to manage patients with depression, which has resulted in dramatic improvements in patient outcomes.

The traditional fee-for-service system is a barrier to this kind of teamwork, since most specialists are paid for face-to-face visits with patients, but not when they provide advice directly to the primary care physician.

By better integrating mental health and mental illness into the rest of medical care, we will be able to make more needed resources available to treat more people.

The emergence of multispecialty groups that include a focus on mental health should increase the awareness of both the treatment and prevention of mental illness.

Those at great risk

The need for integration is great. For years, we have worked to combat known disparities in mental health care among racial and ethnic minorities and in rural communities.

We also know that mental illness is a real threat for our aging population, especially among people with chronic diseases. Early detection via regular screenings and effective treatment of mental illness associated with chronic diseases is important in achieving better health outcomes for those people.

Further, according to an AMA report on “Demographics and the health status of the U.S. population: Trends worth watching,” nearly a third of Americans reported having some form of mental or emotional problem every month. Young adults, ages 18—24 years, reported the most mental health distress (link).

Sadly, mental health needs are also front-page news these days as we see so many members of our military returning home from Afghanistan and Iraq with PTSD, or posttraumatic stress disorder.

I am proud that the AMA has taken steps to support our military community by becoming part of the Joining Forces Initiative, a national coordinated effort for our service members who need our support (link).

A key aspect of Joining Forces involves educating physicians and other health professionals to make sure veterans get the care they need — including mental health care.

Although the majority of military personnel return from war without injury, PTSD affects one in five soldiers. A 2008 report by the RAND Corp. estimated that 300,000 service members had developed PTSD or major depression stemming from deployments to Afghanistan or Iraq.

Schools taking part in the Joining Forces program have pledged to ensure that future physicians are taught the clinical challenges of caring for veterans and other service members. Many of these men and women are in their 20s and 30s but will need treatment over their lifetimes.

Through Joining Forces, physician training will be augmented by more research and clinical trials so that we can better understand and treat these conditions.

So far, the initiative has gained support from 130 medical education programs nationwide, which have committed to teach future physicians the skills needed to treat these conditions among veterans.

By highlighting these issues to physicians, encouraging continuing medical education activities and working with Joining Forces initiative partners, the AMA is committed to ensuring that service members and their families get not just our thanks but also the quality care they deserve for as long as they need it.

In November, when Americans traditionally honor our military veterans, and later when we join together for our Thanksgiving holiday, it is only appropriate to bring special attention to the needs of those individuals who have given far more of themselves than is required from those of us whom they serve and protect.

When something is wrong in the brain or the mind, it affects the whole person. As we continue to work to reform our health care system, we cannot overlook the importance of including mental health care in the equation.

Jeremy A. Lazarus, MD , a Denver psychiatrist and immediate past president of the AMA.

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