State Leadership Conference

Only 28 percent of patients with psychological conditions head straight to mental health professionals for help, said speakers during a session on collaborative care at the 2008 State Leadership Conference.

Sixty-eight percent of patients first visit their primary-care physicians (PCPs), usually with physical symptoms of depression and anxiety, such as upset stomachs or fatigue, said speakers.

As a result, PCPs write 50 percent to 70 percent of psychotropic prescriptions in the United States. Time constraints often limit PCPs to brief consults that preclude delving deeper into the patient's distress and a full discussion of appropriate expectations for the medication.

By working with physicians, psychologists can facilitate patient care, help PCP's implement behavioral interventions, enhance communication between physicians and patients and help reduce burnout among physicians who manage challenging medical situations.

"God gave us a neck for a reason - our mind and our body are linked together, and if we're not treating it together we're not optimizing patient care," said speaker Nancy Breen Ruddy, PhD, a psychologist on the behavioral science faculty at Hunterdon Family Practice Residency in Flemington, N.J.

Yet despite benefits for all involved, many psychologists don't routinely collaborate with physicians. Some resist greater interaction with medicine out of fear of "being subsumed by the medical behemoth," said speaker William B. Gunn, PhD, director of primary-care behavioral health at Dartmouth Family Medical Residency in Concord, N.H.

Other psychologists are intimidated by the medical environment and feel that physicians don't value their input. However, the opposite is usually true, said Ruddy. "I think physicians are looking for help."

To better collaborate with physicians, the speakers recommended that psychologists:

  • Situate themselves. As in real estate, the key to collaboration is location. The more barriers patients must cross to get from a referring physician to a psychologist, the less likely they are to go. Psychologists' offices should be physically close to the physicians' offices and ideally within it, said Gunn.

  • Follow up. PCPs complain that after referring patients, they never receive feedback from psychologists, said session discussant James Bray, PhD, APA president-elect. Psychologists should send a short note with their assessment and treatment plan to the referring physician.

  • Use health and behavior codes. These codes were created so that psychologists could be reimbursed for providing services to patients with a physical, rather than a mental, health diagnosis. Speakers urged psychologists to continue to use the codes. "We need to be persistent," said Ruddy. She suggested that psychologists who use these codes and are denied reimbursement contact government relations staff in the Practice Directorate at e-mail or (202) 336-5889.

  • Befriend office staff. Physicians' practice managers and administrators can help facilitate collaborative relationships, said speakers. These personnel have strong relationships with insurance companies and can help.

Speakers also encouraged psychology leaders and state associations to co-sponsor programs, conferences and task forces with medical professional organizations; create mentorship networks of collaborative providers; train psychologists in the use of health and behavior codes and educate students and early-career psychologists in primary-care psychology.

"I have yet to meet a single person who works collaboratively who doesn't love it," said Ruddy.

-E. Packard

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