Although many people associate primary care visits with physical health care, increasing numbers of primary care providers now care for patients’ mental health.
At The Good Clinicspan styling=”font-weight 400 ;”>, A group of primary care clinics in six Twin Cities, nurse practitioners offer mental and behavioral support to clients through screening and treatment of anxiety and depression. Sometimes, this includes prescribing antidepressants or other psychiatric medications.
span style=”font weight: 400 We can manage many behavioral issues,” stated Kevin Lee Smith, DNP and Good Clinic chief nurse practitioner officer. We can prescribe mental health medication depending on the individual. If someone is suffering from more severe depression or anxiety, we can refer them to counseling, psychology, or psychiatry.
Smith stated that the offering of these services is an extension of the “person-centered”, primary-care-oriented approach to health care.
span style=”font weight: 400 Addressing mental health problems has been an integral part of our approach since the beginning,” he said. Smith explained that the Good Clinic’s leadership looked at gaps in health care, particularly primary care, when they set out to create it. There were many opportunities to improve mental health care for our clients.
Smith stated that an increasing number of Americans seek mental health support through their primary care providers rather than mental health-focused providers such as psychiatrists and psychologists. This trend can be explained by many factors.
He said that for some people, there’s a barrier to accessing mental health services. They fear they will have to see a specialist or are afraid of being treated by a counselor or psychologist.
People are more likely to be familiar with their primary healthcare provider and primary care clinics offer routine screenings of common mental health conditions. As a result, they are increasingly turning to them for help with their mental and/or behavioral health concerns.
Smith stated that one of the main reasons that so many behavioral health services are offered in primary care clinics, is because of the trust that has been built over time through repeated visits. It is possible for clients to discuss their mental health issues if they have that trust.
Additional treatment options
The Good Clinic has begun offering clients GeneSight genetic testing to determine how they may react to certain mental health medications. This is an extension of its behavioral and mental health support services. This option is useful to avoid multiple medication trials, as not all mental health medications work for everyone.
GeneSight tests used to be only available to large medical institutions such as the Mayo Clinic span style=”font weight: 400 ;”>,, but they are now available to smaller providers. Smith stated that staff at Good Clinic were thrilled to offer this option for clients. It is done with a cheek swab and can be performed in a doctor’s office or at your home. However, it must be requested by a healthcare professional. After the swab is completed, the lab will analyze it and issue a report that is color-coded. This report lists medications that can be used as directed (green), are likely to cause mild to moderate gene-drug interactions (yellow), or have significant history of such interaction (red).
Smith stated that GeneSight was a tool that he and his colleagues created to make it easier for clients to find the right mental health medication.
span style=”font weight: 400 For many antidepressant medication providers, it is common to ask patients to take the medication for at least 4 to 6 weeks to determine if they are getting the desired benefit. If the medication does not have a positive effect, the dosage could be adjusted. Or the patient may need to take another medication to test if it works.
This time commitment might be acceptable for one or two rounds. However, patients often need to test multiple medications before finding the right medication. Patients who are given long trial periods with less than ideal results or side effects will often drop out.
span style=”font weight: 400 With GeneSight testing,” Smith stated that “you can determine right away whether this person will properly metabolize the medication.” This saves you a lot of time.
Paul Linson, a lead nurse practitioner at The Good Clinic’s St. Louis Park branch, has used GeneSight testing to help several of his patients. He stated that the test helped him find the right medication for his patients in a shorter time.
Linson stated that GeneSight has been used for many reasons. The test guided treatment when the client wanted to begin with something precise from the beginning. It can also be used to guide therapy for people who have tried different medications, which didn’t work, or had side effects. span>In each case, we found the information from the test to be very useful span>
Longer appointments
The Good Clinic was established and is staffed nursesspan styling=”font-weight 400 ;”>. Smith explained that the philosophy in this field of medicine is more holistic and focuses on the individual client’s needs. Smith explained that nurses practitioners are focused on the bio-psychosocial person. “We don’t just work with people with conditions. It is impossible to treat a condition without understanding the context.
Smith explained that this type of patient care approach requires providers to take the time to get to know their clients. This means that care discussions often go beyond the realm of physical health. Smith said that addressing mental and behavioral health is an important component. This has been a part of primary care for a long time.
Treating the whole patient requires more time than a classic “blood pressure-reflexes-weight” checkup. Smith stated that Smith designed his schedule around allowing clients to speak freely about their concerns. Our appointments last between 30-60 minutes. We take the time to get to know the individual and their concerns.
Smith stated that extra time can often allow patients to establish a relationship and share more about their mental health.
span style=”font weight: 400 In most clinics, all clients who come through receive screenings for anxiety and depression. These are great tools. However, you need to slow down and take the time to build a relationship. It is important to have the dialogue.
Smith explained that Good Clinic nurse practitioners help clients to understand the possible connections between their mental and physical health. He explained that all bodily systems are connected as one, and that they work together.
Smith stated that it is not uncommon for clients to see Smith for treatment for a physical problem, but then leave thinking there may be a connection with their mental health. “I would generally say that those who are seeking treatment for their mental health problems are also seeing us for other reasons. Sometimes their mental health is not the main reason they visit us. It is usually an issue that arises from their need for other types of care.
Smith stated that helping clients to make these connections can help them gain a better understanding of the human body’s workings. Clients often don’t realize the link between their mental and physical health problems. We look at each client individually and consider all components of their mental and physical health. Then we treat them equally. These connections are very strong.”
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