Preventative Psychiatry?

[heartsink]

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I was speaking with a friend recently that mentioned in passing that students at her university (and in college in general) are at higher risk for things like depression and anxiety due to high levels of pressure to succeed.

It got me thinking about current the stigma that treating mental health still has today in 2015. There are some students and young professionals I know who refuse to see psychiatrists or counselors because of the remote possibility that somewhere, somehow, it could come up in an interview or back-grounding for a school or job that they were seeking mental healthcare at one point in their life.

With primary care, its completely acceptable to visit your local doctor for check ups and no one assumes anything is wrong -- its just good practice, much like a dentist visit. With mental health, the opposite is assumed.

I would guess that if such a thing existed it would be more in the domain of MHC's or other mid-levels if it was just on the order of a "check up", but do any of you currently include this kind of "preventative mental healthcare" in your practice? I'm guessing not because unless its your own private practice and it was just up to you, you probably could not bill much for it on your employers behalf, but I thought I'd ask and get this discussion going.

edit; to clarify, I'm asking if anyone sees patients who come in with no claim of having issues of any kind and are interviewed by a mental health professional on a consistent basis so that the clinician can pick up on problems on the rise for the patient.

 

[shan564]

Every psychiatrist in the universe is already 100% booked just seeing the patients with active mental illness. I like the idea of watching patients prophylactically, but we'd need to train a LOT more psychiatrists to make that possible.

But in general, preventive care should be the domain of primary care physicians, not specialists. Specialists should see patients who are too complicated for a generalist's level of training.

 

[smalltownpsych]

This could be a great role for psychologists and I actually do see a few patients in that capacity where we just deal with more transitory stressors. As you mentioned though, the stigma of mental illness is significant and once you have been in treatment for a mental illness then there are times that you would be asked to disclose and document it. There is usually no distinction between serious mental illness and depressed because of loss of loved one, for example. Or even "want to get some parenting tips for my difficult child" or "both of us are in our second marriage and don't want to repeat the same poor communication patterns". This gets complicated by how insurance reimburses. In other words, there is no equivalent of well-care or recognition that anxiety and depression are the common cold of mental illness. We all know if a cough persists for two weeks, see a doctor, but if you are feeling anxious or depressed for two weeks, why not see a doctor?

The main problem I have with that front-line person being the primary care physician is that leads to the first line treatment often being a medication. At our hospital we, the psychologists, work closely with the medical providers so most of them have a pretty good understanding of how to work with us and many of our patients come to us first anyway. Even so, they do seem a bit quick to prescribe for relatively mild cases, but that could also be related to what patient is asking for. After all, I think there has been some research that indicates physicians prescribe more antibiotics than they know they should because of patient pressure.