Integrated Behavioral Health in Primary Care

The COVID-19 pandemic marked a major shift in the way the world views and treats mental health. Most people experienced upheaval to their daily routines and periods of social isolation. Parents juggled added challenges of caring for children when schools closed. Others faced mounting financial pressures. All of these changes affected people in different ways. For some, the pandemic changes worsened existing mental health conditions, such as anxiety and depression. Others may have experienced mental health challenges or substance use disorders for the first time. 

According to the World Health Organization (WHO), the global prevalence of anxiety and depression increased by a massive 25% in the first year of the pandemic alone. And as rates of mental health conditions rose, a growing number of people needed medical treatment, counseling services, and other mental health support.

In The U.S. National Pandemic Emotional Impact Report, women younger than 50 reported more pandemic-related changes relative to men of the same age in terms of sleep, health worries, productivity, mood, and frustration with not being able to do as many enjoyable activities. Women with children younger than 18 also reported elevated rates of anxiety symptoms compared to women with no minor children, as well as compared to men who had children of similar ages.

If you’ve been struggling with worries about a mental health condition or substance use disorder, you’re not alone. Your primary care provider (PCP) is a trusted source who can help connect you with the care you need. Asking for help can be difficult, but together with your PCP, you can take steps to address your condition and take back control of your mental health through holistic care.

What are signs and symptoms of a mental health condition?

It can be difficult to tell when you’re struggling with a mental health condition. Sometimes, symptoms of disorders such as depression or anxiety can look like regular mood swings or reactions to changes in your life. However, if you suspect you may be struggling—and especially if you believe your symptoms are interfering with your daily life—it is important that you contact your provider right away. They can help you figure out what’s going on and work with you to choose the best course of action.

According to the National Institute of Mental Health, common symptoms of mental health conditions can include:

• Lasting sad, anxious, or “empty” mood
• Feelings of guilt, worthlessness, helplessness, and/or hopelessness or pessimism
• Decreased energy or fatigue
• Trouble sleeping, early morning awakening, or oversleeping
• Loss of interest or pleasure in hobbies and activities
• Moving or talking more slowly than usual, and/or feeling restless and having trouble sitting still
• Trouble concentrating, remembering, or making decisions
• Changes in appetite or weight
• Thoughts of death or suicide, or suicide attempts
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause that do not ease even with treatment

If you believe you may be struggling with a condition, like anxiety or depression, it’s important to be direct with your PCP. You can bring it up to your doctor at an upcoming physical exam, or you may choose to make an appointment to discuss your condition specifically.

It can be helpful to prepare for this conversation by taking notes on your symptoms, ways in which you feel your life is impacted, and when you first began feeling this way. Consider also noting whether any of your family members have a history of struggles with mental illness or substance abuse. This can be helpful for medical providers in understanding your condition.

Why begin with a PCP?

You already know that navigating health care—mental health or otherwise—can be a challenge. And you’ve likely gone through that challenge to identify a PCP that was a great fit for you. By putting your trust in a PCP with whom you have a good relationship, you’re allowing your provider to use their extensive knowledge of you and your medical history to connect you with treatments and providers who can make a difference in your life.

If you and your PCP decide that behavioral health treatment is a good first step, your PCP may prescribe medication or refer you to a psychiatrist, therapist, or other mental health care provider. If you have any questions or worries about what to expect at your first appointment, ask your PCP. They can help you manage any concerns.

The great thing about your PCP’s role in managing your care team is that they can work together with your psychiatrist and any other providers to manage your medications and help monitor your progress in ways that feel right to you. This level of holistic, coordinated care can help ensure that you can manage your condition and integrate treatment with total wellness. 

Explore your questions

During your conversation with your PCP, you may have questions or concerns about the process. You should feel comfortable asking your doctor anything during this time. Wondering whether you’re a candidate for a specific kind of treatment or medication? Nervous about side effects? Anxious to meet a new therapist for the first time? This is an excellent time to gain some certainty around the next steps in your treatment.

Collaborative mental health care

When your energy is at a premium, access to high-quality, convenient care is more important than ever. Mass General Brigham Integrated Care provides a relationship-centered approach to behavioral health by getting to know the whole you. Our patients can access multiple health care services—including primary care and behavioral health—in one location that’s convenient for you. This model ensures seamless referrals from PCPs to behavioral health care providers, clear communications and easy access to care.