Does Primary Care Fill the Gap in Access to Specialty Mental Health Care? A Mixed Methods Study

Abstract

Background: Broad consensus supports the use of primary care to address unmet need for mental health treatment.

Objective: To better understand whether primary care filled the gap when individuals were unable to access specialty mental health care.

Design: 2018 mixed methods study with a national US internet survey (completion rate 66%) and follow-up interviews.

Participants: Privately insured English-speaking adults ages 18-64 reporting serious psychological distress that used an outpatient mental health provider in the last year or attempted to use a mental health provider but did not ultimately use specialty services (N = 428). Follow-up interviews were conducted with 30 survey respondents.

Main measures: Whether survey respondents obtained mental health care from their primary care provider (PCP), and if so, the rating of that care on a 1 to 10 scale, with ratings of 9 or 10 considered highly rated. Interviews explored patient-reported barriers and facilitators to engagement and satisfaction with care provided by PCPs.

Key results: Of the 22% that reported they tried to but did not access specialty mental health care, 53% reported receiving mental health care from a PCP. Respondents receiving care only from their PCP were less likely to rate their PCP care highly (21% versus 48%; p = 0.01). Interviewees reported experiences with PCP-provided mental health care related to three major themes: PCP engagement, relationship with the PCP, and PCP role.

Conclusions: Primary care is partially filling the gap for mental health treatment when specialty care is not available. Patient experiences reinforce the need for screening and follow-up in primary care, clinician training, and referral to a trusted specialty consultant when needed.

Keywords: Mental health access; Primary care; Private health insurance.