Mercedes Dodge spent 15 years working as a physician associate (PA) in everything from chronic care management to pediatrics before she stumbled into what might just be her most important role yet. Dodge treats telehealth patients in Alaska as a psychiatric PA while also training other primary care providers to support patients’ mental health needs.
Dodge’s transition to psychiatric care couldn’t have come at a better time. The mental health crisis in the U.S. is at an all-time high. One in five U.S. adults and one in six youth experience mental illness each year, according to NAMI.
There aren’t enough psychiatric clinicians to meet the growing demand. Primary care providers working in areas like internal medicine, geriatrics and pediatrics, are an important bridge to fill the care gap.
Dodge says physician associates (formerly known as physician assistants) are ideal candidates for meeting psychiatric care needs. “PAs are like chameleons, meaning they can change depending on what a practice needs.”
Integrating mental health care and primary care
Dodge’s model for how primary care providers can treat mental health issues comes from her experience working in a community health clinic in California. There, it wasn’t unusual for her to see patients trying to manage psychiatric conditions, like schizophrenia, without being able to see a psychiatrist. Fortunately for her patients, the clinic had a psychiatrist consultant as a resource. Providers could work with the psychiatrist to find out how to help patients until they can see a psychiatrist.
The more Dodge treated primary care patients with mental health issues, the more she saw a need for additional training. Dodge joined a training certificate program at UC Irvine, focusing on integrating psychiatric and general medical practice. The program helps providers learn to recognize early symptoms of common psychiatric conditions, complete a targeted assessment and provide evidence-based treatment. In addition, Dodge learned how to train other providers in her clinic and region to integrate psychiatry into their primary care.
The need for this kind of training is great. Up to 75% of primary care visits include mental or behavioral health components, according to Behavioral Consultation and Primary Care: A Guide to Integrating Services.
“There’s a fear with clinicians in general that we don’t have enough education in mental health. But what we’re seeing is that we have to learn as we go because this mental health epidemic has bombarded us,” she says.
For her colleagues working in primary care, Dodge suggests three main ways to integrate mental health care into primary care.
- Collaborative care integrative models
The AIMS Center at the University of Washington has a collaborative care model for primary care providers (PCP). The model allows PCPs to use the Patient Health Questionnaire 9 (PHQ-9) to identify those patients who need more mental health support. Patients who score high can then access ongoing treatment and medication from their PCP, with the help of psychiatry consultants.
- Get comfortable doing suicide screenings
Primary care clinicians need to get comfortable asking patients about suicide and self-harm. Dodge recommends continuously reviewing the current education on suicide assessment, interventions and risk stratification. “The more we can get that education and support, the more we can do it competently,” says Dodge.
- Make time for connection and compassion
Primary care providers often have rushed appointments, especially in institutions like hospitals. But mental health discussions are delicate. They require trust and time. The more clinicians focus on connecting to patients, the more likely they will be able to identify mental health challenges.
As a PA, Dodge says those in her field are especially positioned to integrate mental health and primary care. PAs are trained to focus on every area of medicine and to work with all kinds of providers. “The cornerstone of being a PA is collaboration.”
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