UW Medicine program helps primary care providers treat mental health
When treating patients, primary care providers are often the first to see signs of underlying mental health problems. Most of the time, that means they’ll refer patients to a specialist for more treatment.
But a UW Medicine program is trying to train more primary care providers to respond directly when patients have common mental health needs.
Run by UW Psychiatry and Behavioral Sciences, the fellowship teaches primary care providers — including doctors, nurse practitioners, osteopaths and physician assistants — how to assess and offer some treatment options for people with a variety of mental health needs. Since launching this past January, 28 people have taken the training, across two six-month sessions. “Access to care is actually the bigger goal, because access to care, especially in mental health, is so limited,” said Dr.
Ramanpreet Toor, the UW Medicine psychiatrist who founded and leads the training program. “I always tell them, the goal is that you can take the first two steps. If patients get better, then they’re good.
If they don’t, they can be referred to a psychiatrist.” Providers who’ve taken the course say it helps them respond to the widespread mental health needs they see in their daily work. “Going into primary care, I didn’t know that I would be managing as much mental health as I am,” said Julie Suter, a primary care nurse practitioner at UW. “I would say 75% of primary visits include mental health or behavioral health concerns.” Mental and physical health are inextricably linked, she said, and come up when treating a variety of conditions, from diabetes and autoimmune disorders to substance use disorders. The fellowship is open by application, and free to anyone who practices medicine in Washington.
Prior experience treating mental health conditions is not required. Applications for the upcoming session have closed, but those interested can apply for the session that starts in August.
The training program spans six months, and is completely online. Participants do some self-guided coursework, like watching recorded videos and slideshows, then gather for a virtual training with Toor every month on a different topic.
Toor said the training covers four main areas of mental health challenges: mood disorders (such as depression or bipolar), anxiety disorders, trauma and attention-deficit/hyperactivity disorder. In each session, Toor talks about how to assess and evaluate each disorder, how to talk to patients about it and different ways to treat it — from medication to psychosocial interventions.
Another session, the first in the series, talks more broadly about conducting mental health assessments, how to think about suicide and mental health, and different intervention techniques. The University of Washington developed the “collaborative care model” about 20 years ago.
A psychiatric provider works in tandem with a primary care provider and a behavioral health manager to keep track of a patient’s mental health and progress over time. Toor said the training program builds on the same principles, but is open to anyone who wants to integrate more mental health treatment into their care, not just those at clinics that already have that model. “In internal and family medicine, they get very minimal exposure to mental health treatment, but they’re managing that the most.
So this is to give them tools,” Toor said. Toor said she hopes more providers from around the state, particularly rural areas, will apply for future trainings.
In the year since the program launched, more than half its participants have come from King County and nearly all from Western Washington. She said some providers who have done the training say it’s given them more confidence in prescribing and managing medication, or learning about mental health counseling resources that they can recommend to patients.
Suter said that while primary care providers may not have the answers to all of a patient’s mental health needs, the program has given her more confidence to approach those concerns and reassure patients that it’s something they can work on together. “I’m by no means an expert in ADHD or bipolar, but I think this program helped to really learn how to get someone stable,” she said. “Perhaps I don’t feel comfortable diagnosing ADHD, but if someone has that diagnosis, I can help get them started on treatment.” While mental health has significant impacts on physical health, people may be reluctant to seek out a specific mental health provider, Suter said. Integrating behavioral health care into routine physical checkups can help people feel more comfortable discussing those topics with someone they already trust. “I think the push to integrate mental health screening and improve treatment with primary care is a way to meet people where they are,” Suter said.