Mental health concerns among adults and children were common even before they were greatly exacerbated by the strains of the COVID-19 pandemic, all the while the U.S. health system’s capacity to meet the growing need has been limited due in part to the national shortage of psychiatrists and other behavioral health specialists.
But there are brief, evidence-based interventions primary care physicians can do to better engage their patients in their mental and behavioral health.
“The primary care physician is really the most important ingredient for success,” and their care recommendations “are really very powerful,” according to clinical psychologist Patrick J. Raue, PhD, who took part in an AMA-hosted webinar exploring the value of brief, physician-delivered psychosocial strategies for patients and outlining how to incorporate these strategies into your practice.
The webinar is part of the “Overcoming Obstacles” series offered by the Behavioral Health Integration Collaborative, which the AMA established with seven other leading physician organizations to catalyze effective and sustainable integration of behavioral and mental health care into physician practices. The webinar is part of the AMA STEPS Forward® Innovation Academy.
Raue, associate director for evidence-based psychosocial interventions at the AIMS Center at the University of Washington, detailed these key messages to deliver to patients:
- There are a variety of treatment options for mental and behaviorial health concerns.
- Sometimes, the first treatment approach for a behavioral health concern may not be as effective as a patient would like, but there are a lot of options and the physician and patient will work together as a team to find good solutions. It’s an approach called proactive persistence.
- An overall message of hope, that the physician and patient will work together as a team to find good solutions.
Here are three evidence-based psychosocial strategies to use in delivering those key messages.
Psychoeducation
The aim is not just to impart medical knowledge, but to engage in a conversation with the patient. For example:
- Provide information about symptoms and impairment.
- Share the medical term used for those symptoms and impairments.
- Inform the patient about the known causes and prognosis.
- Discuss what treatments are known to be effective and which are known to be ineffective.
- Help the patient develop self-management skills and empower them.
- Provide space for the patient’s questions and concerns.
- Address any myths or individual or cultural differences in our understanding of behavioral health symptoms.
Motivational interviewing
This is a collaborative, goal-oriented style of communication that pays attention to the patient’s language of change, strengthens personal motivation for and commitment to a specific goal, elicits and explores a patient’s own reason for change and creates an atmosphere of acceptance and compassion.
Raue and psychologist Cody A. Hostutler, PhD, clinical director of behavioral health integration at Nationwide Children’s Hospital in Columbus, Ohio, shared the OARS model that guides physicians on how to have the discussion. Here is an example of how to use the OARS technique with an adolescent patient:
- Open-ended questions: “How would you describe what you’re feeling?”
- Affirmations: “I remember when you were struggling with math and got extra help to improve your grades.”
- Reflective listening: “I hear you saying that you’ve been struggling with feeling more depressed and anxious now, but are unsure how your parents will feel about you asking for help.”
- Summarizing: “It sounds like we have a plan you are comfortable with. You are OK looking over these handouts that talk about what depression is and how it is treated. Next time we can talk about options for getting help that you would be interested in. And for now, you are interested in just saying hello to our integrated BH provider.”
Shared decision-making
Sharing the decision-making can help ensure the patient transitions from the physician to the behavioral health professional, Hostutler said. Here are some ways to create a shared decision-making process:
- Review and understand the patient’s behavioral health symptoms and the impact on their functioning.
- Provide depression psychoeducation.
- Find out whether patients have had prior treatment experiences, what their preferences and values are.
- Use decision aid materials.
- Arrive at a mutually agreed upon decision and provide that treatment.
Learn more by exploring this compendium of behavioral health integration resources for physician practices.
