Insight Matters
Fall, 2004

Psychiatrists and primary care physicians working together
by Herman A. Tolbert, M.D., President

In an era of decreased funding, increased need and improved outcomes for mental health services, collaboration and communication between psychiatrists and primary care physicians are becoming increasing critical. Despite our natural need for collaboration, the relationship between psychiatry and primary care has sometimes been challenged by poor communication, lack of personal contact and external barriers to care.

As a result of a recent meeting between OPA Executive Director, Janet Shaw and the Ohio Academy of Family Physician's Executive Vice President, Ann Spicer, the OPA was invited to attend a recent meeting of the Ohio Coalition of Primary Care Physicians to discuss issues we might have in common and might be able to pursue jointly. Ms. Shaw and I attended the meeting and I was pleased with the warm reception we received and that we were already concerned about many of the same issues.

Following our presentation and a candid discussion among all the participants, we were invited to return to the Coalition's next meeting, which will be held in February, to continue the dialogue, especially as it relates to managed care organizations' hierarchy. This promises to be a fruitful exchange for patients and all physician providers. A summary of our focus points follows. Please contact me to share any additional issues you think we should explore.

Cordially,

Herman A. Tolbert, M.D., President

Highlights of the OPA's presentation to the Ohio Coalition of Primary Care Physicians as noted in Coalition's summary notes -

Dr. Tolbert reviewed what he hoped might be shared issues of interest and areas of possible collaboration. Dr. Tolbert explained his association's interest in the Ohio Commission to Reform Medicaid (without third party coverage, people with mental illness will not be seen), managed care constraints (psychiatrists are only being approved for medication therapy/counseling is all done by psychologists), state budget provisions for public mental health, increased visits to emergency rooms, and treating the homeless population in the free clinic setting.

The OPA's present initiatives include an April 2005 educational event in collaboration with The Ohio State University Medical Center, patient identified education in collaboration with the Franklin County Mental Health Association, collaboration with the Coalition for Healthy Communities and the National Alliance for the Mentally Ill (NAMI), Crisis Intervention Team training, a collaborative effort between law enforcement and the mental health community to help law enforcement officers handle incidents involving mentally ill people, and jail diversion programs (a huge number of those in prisons have mental health problems) efforts to ensure that people with mental illness get treatment when appropriate, rather than unnecessary and/or inappropriate incarceration.

The OPA also hopes to help others (physicians, patients, schools) better understand mental illness and its relationship to other physical ailments such as diabetes, stroke, heart issues).

Mental health parity is the key agenda item from a legislative standpoint. Coalition members were very interested and supportive of mental health parity and shared their frustrations about reimbursement, coding, referrals within the managed care system, primary care physicians being carved out of being reimbursed for mental health treatment when there aren't enough psychiatrists to see the people who need seen, etc. Frustration with the lack of communication back to the primary care physicians from the psychiatrist following a referral was expressed as well (full well understanding the privacy issues related to this issue). It was suggested that referral patterns could conceivably flow both ways - from primary care physician to psychiatrist and from psychiatrist to primary care physician. It was suggested that representatives from the Ohio Psychiatric Association be invited back to the next meeting and that several representatives from the Ohio Association of Health Plans medical directors committee be invited as well to discuss these concerns.

Ohio Coalition of Primary Care Physicians Participants

Ohio Academy of Family Physicians
Ohio Osteopathic Association
Ohio Chapter, ACP-American Society of Internal Medicine
Ohio State Society, American College of Osteopathic Family Physicians
Ohio Chapter, American Academy of Pediatrics
Ohio Section, American College of Obstetricians and Gynecologists

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