Patients at Urban Primary Care Clinics Need Better Mental Health Treatment

Nearly half of patients at an urban primary care clinic affiliated with a large academic medical center had a diagnosed mental health problem.

Nearly half of patients at an urban primary care clinic affiliated with a large academic medical center had a diagnosed mental health problem, according to a new study in the February 2016 issue of the Journal of Health Care for the Poor and Underserved.

Mental health problems are a major source of disability worldwide but are often overlooked as a public health concern. As such, it is important to know about the true prevalence of mental health disorders in primary care settings, and among minority populations that are typically underserved.

“Often, mental health problems are first detected within primary care settings, and there has been increased emphasis on detection and treatment within primary care when patients are seeking treatment for other chronic diseases,” the authors wrote.

However, not only is there a lack of information about the prevalence of mental disorders in the primary care setting, but less is known about the mental helath burden on racial/ethnic minority patients.

The study examined the medical records of 767 patients at the BJC Center for Outpatient Health (COH) in St. Louis, MO. The patients were at the clinic seeking medical care as outpatients and agreed to have data taken from their electronic medical record, which also contained mental health data.

The researchers, led by Darrell L. Hudson, professor at the Brown School at Washington University in St. Louis, said that depression was the most commonly reported form of mental health problem. Overall, 45% of patients had a diagnosed mental health problem, and African Americans were more likely than whites to have a diagnosed mental health problem (odds ratio, 1.88; confidence interval, 1.21-2.91), as were Medicaid patients.

“These results suggest a strong mental health treatment need among patients seeking primary care in urban settings,” the researchers wrote.

Dr Hudson said the most important takeaway from the study is the high prevalence of mental health conditions among the population.

“The data suggest that COH providers may be doing a good job of identifying mental health conditions and because the COH is a comprehensive facility with mental health specialty care within the same building, perhaps patients with mental health conditions are more likely to receive mental health care," he said in a statement.

He suggested that other healthcare organizations and facilities may uncover unmet mental health needs if they move to more integrated, coordinated models of care.

“The evidence garnered from this study underscores the need to detect and treat mental health problems systematically within outpatient primary care clinics that serve similarly vulnerable populations,” the authors concluded.