Health plans seldom require screening for substance abuse and mental health in primary care even though it can improve detection, according to a new Brandeis University study published in the July issue of the Journal of General Internal Medicine. This may be a missed opportunity to help people with mental illness or substance abuse problems, only a fraction of whom currently receive treatment.
Lead author Constance Horgan, director of the Institute for Behavioral Health at the Heller School for Social Policy and Management at Brandeis, says that requiring health plans to screen patients for mental health and substance abuse problems could help identify more people with behavioral health conditions, the first step toward effective treatment.
Horgan and her colleagues recommend that patients be routinely screened in primary care settings for several reasons. First, primary care physicians have contact with the greatest number of patients. In 2001, sixty-eight percent of adults reported an appointment with a primary care doctor within the last year. Second, there are many effective tools for screening available. Third, screening, when combined with appropriate treatment, has proven to help patients.
"There is a growing emphasis on the role of primary care doctors in addressing behavioral health problems, and screening for mental health issues and substance abuse is one important strategy that physicians can use to identify problems and get patients into treatment," says Horgan.
Despite these reasons, most health plans do not require primary care physicians to screen for mental health or substance use problems. By 2003, only thirty-four percent of health insurance products had any behavioral health screening requirements, according to the national Brandeis study of private health plans. Horgan and her colleagues believe that requiring health plans to screen for behavioral health conditions will help close this gap.
"I think it's time we made screening for behavioral health problems as routine as it is for cancer and other major illnesses," says Horgan. "Detection is where treatment really starts."
The study was funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse.
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