Mental disorders are so common that 1 in 5 Americans will deal with mental illness at some point in their lives — and many of these conditions and related symptoms are treatable. According to the National Institute of Mental Health, approximately 47 million U.S. adults grappled with some type of mental, behavioral or emotional disorder in 2018. Only 43% of those patients requiring treatment received it. The COVID-19 pandemic forced people into isolation, which can further exacerbate mental health symptoms and conditions. Primary care physicians are often the first line of defense against worsening mental health conditions, since they are sometimes the only health care provider a patient sees in a given year.

Treating mental health as a primary care physician

While primary care providers are not extensively trained in mental health care, patients will often mention mental health concerns to them first. There are links between mental and physical health.

“Mental illness can present as a physical ailment,” said Monalisa M. Tailor, M.D., internal medicine physician with Norton Community Medical Associates. “Physical illness can cause symptoms such as distress, anxiety and depression, gastrointestinal upset, heart racing episodes and difficulty sleeping.”

According to the Centers for Disease Control and Prevention (CDC), one-fifth of all primary care visits address mental health concerns, often resulting in at least one mental health “indicator.” These indicators may include a depression screening, a referral to counseling, a mental health diagnosis or a prescription for a psychiatric medication.

How to talk to patients about mental health

“It can feel awkward for either party to talk about mental health issues,” Dr. Tailor said. “It’s important to walk a line between letting the patient’s responses guide the conversation but to also not shy away from those important conversations.” Screening tools such as PHQ9 and GAD7 can be helpful.

Practical tips for talking with patients about mental health

• Make mental health screening part of the overall health and well-being exam. Mental health questions can be incorporated with health history and current health.
• Ask questions about feelings of depression or hopelessness, sleep quality and duration and increases or decreases to appetite.
• Learn more about the patient’s life outside of the exam room and if there are stressors that might contribute to mental health issues.

While physicians should listen to what the patient says, they should be on alert for red flags, including:

• Unexplained pain, fatigue or other symptoms
• Signs of drug or alcohol use (or abuse)
• High rates of infection
• Drastic changes in eating or sleeping habits

“As always, communication skills are key here,” Dr. Tailor said. “Practice active listening and remain nonjudgmental.”

Also know what to do next.

“Based on the answers of the patient and the conversation you have, you want to guide treatment based on what is best for the patient. Most importantly, you want them to know you support them,” Dr. Tailor said.