Helping Primary Care Physicians Make Psychiatric Referrals

A report in the May/June 2009 issue of Health Affairs reveals that at least two-thirds of 6600 primary care physicians (PCPs) were unable to obtain mental health care for their patients.¹ The reasons cited include “manpower shortage” and “inadequate insurance coverage.” This extraordinary figure almost certainly includes problems with the referral process itself. Other factors may include the type of practice (solo vs group) and its location (rural vs urban).

Psychiatrists helping nonpsychiatrists refer their patients has a long but not always illustrious history. Patients admitted to a general hospital with emotional disorders are said to account for 25% of all admissions, yet referrals to consultation-liaison services rarely exceed 10%.^2,3 And studies that have examined the detection and/or management of depression and other affective conditions in primary medical practice report a disappointing 50% failure rate.⁴ PCPs, as de facto mental health providers, are generally the first contact for individuals with emotional disorders; as such, it would be reasonable to expect a more robust referral rate.⁵

It is unlikely that much can readily be done to remedy manpower or reimbursement factors, but reexamination and possible modification of referral practices may enhance the availability and use of mental health services. The education and training model endorsed and promoted for decades by professional organizations such as the AMA, the American Psychiatric Association, the NIMH, the Institute of Medicine, and others has been a startling failure.^6-8 Psychiatrists helping PCPs facilitate appropriate psychiatric referral may be a place to begin.

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