How Doctors Should Talk to Their Patients About Mental Health

During a routine check-up, Dr. Smith noticed that her long-time patient, Alex, seemed more withdrawn than usual. Typically upbeat and chatty, Alex gave short, clipped answers and barely made eye contact. Sensing something was wrong, Dr. Smith saw this as an opportunity to talk to Alex about his mental health. She started asking questions, providing reassurance, and referred Alex to the on-site mental health therapist for further assessment.

However, this isn’t always the reality. Not all primary care providers are comfortable discussing mental health with their patients. Some are confident in their training and will prescribe medication when appropriate. Others, lacking sufficient training, prefer to refer their patients to a community specialist. Unfortunately, nearly two-thirds of PCPs struggle to find therapists to refer their patients to, and a staggering 20% of patient referrals do not come to fruition.

So, what are primary care providers supposed to do? As the front door to mental health care, doctors are understandably swamped with the evolving demands of their patients. Knowing how to talk about mental health, coupled with integrating behavioral health services, will make a world of difference.

If you’re a doctor who’s eager to learn how to talk to their patients about mental health, read ahead:

If they’re speaking up, practice these tips:

• Normalize the Conversation – Reassure your patient that mental health is just as important as physical health and that it’s okay to talk about it – especially with you, their doctor.
  
  
• Active Listening – Show empathy and understanding by listening attentively. Nod, maintain eye contact, and avoid interrupting.
  
  
• Provide Reassurance – Let your patient know that they are not alone and that help is available.
  
  
• Refer – No matter how mild, take their concerns seriously and refer your patient to your on-site Behavioral Health Manager.

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If they’re not speaking up, use the OARS Communication Model

A communications tool that can help doctors build rapport with patients, O.A.R.S. stands for:

• Open-ended questions
• Affirming
• Reflective Listening
• Summarizing

Using the OARs model can help you foster a supportive environment where patients feel heard and understood. Here’s an example of the O.A.R.S model in action when assessing a patient's mental health:

• Open-ended questions: “How have you been feeling lately?” and “Can you tell me more about your recent experiences?”
• Affirmation: “Thank you for sharing that with me. It sounds like you have been going through a lot lately after the divorce.”
• Reflective listening: “So, what I’m hearing is that you’ve been feeling quite overwhelmed and stressed since your divorce. It seems like these feelings have been affecting your sleep, eating habits, and overall mood.”
• Summarizing: “To summarize, you’ve been dealing with a lot of stress lately and it’s impacting your day-to-day. You’ve also mentioned feeling less interested in activities you used to enjoy. It’s important that we address this right away. I think it would be beneficial for you to speak with our on-site mental health therapist.

That last part is key. Whether your patient speaks up or not, it’s always worth referring them to your on-site mental health therapist for prompt, comprehensive mental health care – even if nothing is wrong.

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If you’re unsure, screen

For patients like Alex, who might not openly discuss their struggles, screenings can be a lifeline.

Like checking blood pressure, mental health screenings are just as vital in identifying issues early and providing timely intervention. Screenings can help detect conditions like depression, anxiety, and other mental health disorders that might otherwise go unnoticed.

Screening tools such as the PHQ-9 and GAD-7 are self-assessments, asking patients to indicate their answers from “Not at all” to “Nearly every day” on items including:

• Feeling down, depressed, or hopeless.
• Feeling bad about yourself – or that you are a failure or have let yourself or your family down
• Not being able to stop or control worrying.
• Feeling afraid as if something awful might happen.

Their total scores can indicate mild to severe depression or anxiety. Even if they score low, such as a 5 for mild anxiety, it’s still worth discussing with your patient. Screening is a powerful tool for starting the conversation, and then, like in previous scenarios, refer them to your on-site mental health therapist.

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Whether they speak up or not, always refer your patients
You’ve probably noticed a pattern by now. Referring your patients to mental health specialists is crucial, regardless of whether they openly discuss their struggles. When you integrate behavioral health, having an on-site therapist helps to establish a supportive environment to receive the care they need in a timely manner. By doing so, you can help bridge the gap between physical and mental health care to ensure they live happier, healthier, and more balanced lives.

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