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Some of the most challenging patients for primary-care physicians are those with mental illness. Here's how PAs can help you care for them.
Some of the most challenging patients for primary-care physicians are those with mental illness. Mental health issues are complex, time consuming, and often difficult topics to broach.
I know personally the challenges physicians face in treating patients with mental illness. When I graduated from the PA program at Gannon University, I was hired to be a PA for psychiatric services in a small hospital, an outpatient clinic, and multiple drug and alcohol treatment centers. It was a big step for me as a new clinician.
Because of my solid, general medical education and training, and a supervising physician who trained me on the medical/psychopharmacology connection, I was quickly able to begin effectively caring for these complex patients. PAs work in collaboration with physicians. Although I worked autonomously most of the time, a psychiatrist was always available when I had questions.
PAs can also provide significant value to a general medical practice. PAs are educated and trained to conduct comprehensive medical and mental health assessments, through interviewing and physical examination techniques. Because of this training, they are often the ones to assess behavioral health concerns such as depression, anxiety, addiction, and other common mental health or psychiatric issues.
How can PAs help address mental health issues?
• PAs can assist with identifying mental health issues. With a PA also seeing your patients, it is more likely the two of you will diagnose mental disorders, treat or refer appropriately, and ultimately help patients prevent devastating circumstances like unplanned pregnancies, transmitted disease, or encounter legal and financial issues.
PAs are educated in patient communication and part of that is asking questions about the whole patient. This is the time to ask about depression, anxiety, or substance dependency. Primary care is the early-warning setting where these disorders can be first diagnosed.
It is not easy to identify mental illness on a first visit, particularly if the patient doesn’t bring it up first. However, as PAs often provide the continuity of care on follow up visits, they may be the first to uncover areas of concern.
• PAs can assist with medication management and patient education. PAs are used to treat chronic conditions. Just as with a medical disease like diabetes, PAs also need to re-evaluate their mental health patients regularly. It is best to prescribe minimal medication and have patients come in for frequent follow up. A patient who has been taking addictive anxiety medications may be resistant to trying non-addictive drugs. There are many less habit forming options, and education can play a big part in helping them make the switch to a better, long-term choice.
• PAs can assist with referrals. Practices should have a list of psychologists in the area and be willing to refer for treatment. The success rate skyrockets if a patient seeks therapy along with medication. Many patients want the quick fix of medication, but best practices may dictate therapy as well.
• PAs can be trained by the physician to evaluate patients for buprenorphine and recommend under the physician’s license. This increases the likelihood patients who may be candidates for it will be identified and helped.
How can you support your PA in identifying and treating mental illness?
• Give your PAs the tools they need to help your mental health patients. Even a one-day conference in addiction management is a good refresher to help PAs not only recognize mental illness, but also brush up on non-addictive medications for depression or anxiety.
• Have substance abuse education literature available in your office. A simple handout can speak to a number of audiences: patients, parents, concerned family, and friends.
• Consider encouraging a PA to earn a specialty credential. The National Commission on Certification of Physician Assistants (NCCPA) offers a certificate of added qualifications (CAQ) in psychiatry. The CAQ recognizes those PAs with additional experience and continuing medical education in psychiatry who have also gotten a physician attestation to their knowledge and skills and passed a national specialty exam in psychiatry.
No one patient is the same. No depression is the same. Mental illness usually doesn’t lend itself to the quick fix. Treatment is a process, and PAs can help your patients navigate that journey.
Nelae DeChurch, PA-C, is a certified physician assistant in a private psychiatric practice in Orange County, Calif. There she works with another PA and a psychiatrist treating patients from ages 13 to 65. DeChurch earned the CAQ in psychiatry in 2013 and is dedicated to making a difference to mental health patients.
This blog was provided in partnership with the National Commission on Certification of Physician Assistants.