Primary care treatment of psychiatric disorders

Approximately 30 percent of our population will experience symptoms of a psychiatric disorder over a one year period.

Even though mental illness is extremely common, even in countries like Canada, the UK and the US, the vast majority of psychiatric illness goes undiagnosed and untreated.

Of those who do seek treatment, 95 percent are treated by their family physician.

Unfortunately, in our landscape of doctor shortages, there are only about two family doctors for every 1,000 people in Canada and they are overworked. Given the amount of patients each doctor has to see and the level of expertise and complexity they must face each day, we may be asking more than can reasonably be expected of a single primary care physician.

Mental illness is just one area that can be very complex with numerous factors influencing symptoms and symptoms that can be similar between various disorders. Very often, specialist treatment is needed in order to truly have an accurate diagnosis and treatment strategy.

Most cases of mental illness are unrecognized in primary care and as a result, untreated. It is also very common for psychiatric conditions to be diagnosed incorrectly.

In Canada the family physician is still the gate keeper of the specialist. In order to seek mental health treatment from a psychiatrist, a referral from a family doctor is required and the family doctor can either facilitate or inhibit this process.

Depression is established as the leading cause of disability in developed regions of the world, accounting for 13 percent of all years lived with disability. Only 35 percent of such people are actually treated even though effective treatments are available and can reduce disability by an average of 50 percent.

In BC, the largest proportion of patients who were treated for major depression by primary care physicians between 2000 and 2001 were seen only once in the following year. Unfortunately, this would be considered inadequate by all treatment guidelines for depression.

As primary care physicians become increasingly overwhelmed and unavailable due to shortages and high demand, the recognition of mental illness and many other disorders will become more and more dependent on patients themselves recognizing their own problems and asking for specific treatment or a specialist referral.

Although not always ideal, individuals must become advocates for their healthcare in today’s Canadian health environment. Recognize when you have symptoms and be sure to openly voice any problems to your doctor. Be as aware as possible of treatment options and guidelines and have an open dialogue with your healthcare providers to ensure that you understand which options you will ultimately choose.

As I have mentioned in other columns, appropriate treatment of psychiatric conditions is essential for the long term health and wellbeing of patients. Simply ignoring your symptoms or treating them ineffectively will lead to more disability and increased severity of many conditions over time.


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