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State
of Mind: America 2003:
Discussion Three: Mental Health and Primary Care
Fifty
percent of people with mental illness never see a psychiatrist or
therapist. They receive mental health care from their primary care
doctors -- internists, family practitioners, even gynecologists.
Host Dr. Fred Goodwin's
next two guests discuss the challenges and opportunities this presents.
As 16th Surgeon General of the United States, Dr.
David Satcher released the first-ever Surgeon General's
report on mental health. He now directs the National Center for
Primary Care at the Morehouse School of Medicine here in Atlanta.
Dr. Benjamin Druss is
a psychiatrist and the Rosalynn Carter Endowed Chair in Mental Health
at Emory University's Rollins School of Public Health.
Dr. Druss begins by saying that one of the challenges of diagnosing
mental disorders in primary care offices is that the symptoms often
make it difficult for patients to recognize their illnesses or follow
through with treatment. In addition, the disorders are stigmatized,
and primary care physicians are not always comfortable treating
patients with mental illnesses or diagnosing the diseases.
He offers the hypothetical example of a woman who does not know
she has depression but is experiencing difficulty sleeping and suffering
from headaches and stomachaches. If she goes to her primary care
doctor, she has only a 50% chance that the doctor will recognize
her depression. If the doctor does correctly diagnose her, he or
she may start her on an antidepressant, but, because there are generally
not procedures in place for follow-up, there's only a 50% chance
she will be kept on the medication for the appropriate length of
time.
Dr. Satcher adds that the real problem is that not enough people
are seeking any care for mental disorders. Primary care doctors
are not adequately trained to diagnose mental illnesses. Often physical
health problems and mental health problems coexist, and too many
doctors miss underlying mental disorders. The cost of these missed
diagnoses is high - not only in terms of money spent on medical
care, but also in terms of pain and suffering. Mental health problems
are second only to cardiovascular disease as a cause of disability.
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The Infinite Mind is
supported in part by major underwriting from the John D. and Catherine
T. MacArthur Foundation, the National Institute of Mental Health,
and the Nonprofit Finance Fund. Additional underwriting in the form
of unrestricted educational grants from Eli Lilly and Company and
Bristol-Myers Squibb. Major underwriting for State of Mind: America
2003 was provided in the form of an unrestricted educational grant
from Solvay Pharmaceuticals. Additional support was provided by
Tom and Edwina Johnson, The J. B. Fuqua Foundation and the Turner
Foundation.
The
Infinite Mind is non-profit production of Lichtenstein Creative
Media, in association with the New York Foundation for the Arts
and WNYC/FM.
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