Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Jul 19, 2021; 11(7): 271-276
Published online Jul 19, 2021. doi: 10.5498/wjp.v11.i7.271
Primary care and mental health: Where do we go from here?
Nathalie Moise, Milton Wainberg, Ravi Navin Shah
Nathalie Moise, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY 10032, United States
Milton Wainberg, Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, United States
Milton Wainberg, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032, United States
Ravi Navin Shah, Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10019, United States
Author contributions: Moise N and Shah RN contributed study concept and design; Moise N, Shah RN and Wainberg M contributed acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of manuscript for important intellectual content and statistical analysis; Moise N obtained funding and contributed study supervision.
Supported by National Institute of Mental Health Agency for Healthcare Research and Quality (AHRQ), No. R01HS025198 (to Moise N).
Conflict-of-interest statement: Shah RN is a clinical advisor with < 1% equity interest in the following mental health startups which were not involved in the conduct of this study: Two Chairs, Groupwell, Mantra Health, and Tempest. The other authors declare that they have no competing interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ravi Navin Shah, MD, Assistant Professor, Department of Psychiatry, Columbia University Irving Medical Center, 5 Columbus Circle, 7th Floor, New York, NY 10019, United States. rns2142@cumc.columbia.edu
Received: March 1, 2021
Peer-review started: March 1, 2021
First decision: April 20, 2021
Revised: April 30, 2021
Accepted: June 15, 2021
Article in press: June 15, 2021
Published online: July 19, 2021

Primary care has been dubbed the “de facto” mental health system of the United States since the 1970s. Since then, various forms of mental health delivery models for primary care have proven effective in improving patient outcomes and satisfaction and reducing costs. Despite increases in collaborative care implementation and reimbursement, prevalence rates of major depression in the United States remain unchanged while anxiety and suicide rates continue to climb. Meanwhile, primary care task forces in countries like the United Kingdom and Canada are recommending against depression screening in primary care altogether, citing lack of trials demonstrating improved outcomes in screened vs unscreened patients when the same treatment is available, high false-positive results, and small treatment effects. In this perspective, a primary care physician and two psychiatrists address the question of why we are not making headway in treating common mental health conditions in primary care. In addition, we propose systemic changes to improve the dissemination of mental health treatment in primary care.

Keywords: Mental health, Collaborative care, Primary care, Depression, Integrated care, Anxiety

Core Tip: Primary care has been dubbed the “de facto” mental health system of the United States since the 1970s. Two psychiatrists and an internist at a major academic medical center review difficulties with implementation of collaborative care in academic primary care settings along with novel recommendations to improve dissemination of this evidence based practice.