Rhea Khettry

Dr. Jan Babcock

English 138T

15 March 2024

A Expanded View into Mental Health: Placing Specialists in Primary Care

One of the biggest issues currently present in the US is mental health. Since the topic is so broad,

it has been difficult to find a solution that can accommodate everyone. Beyond that, there was a certain

level of stigma surrounding mental health, which has decreased since the pandemic. During the pandemic,

people began to open about their health struggles, which changed the outlook many people had on it

(Panchal). When it comes to mental health, it is important to look at different approaches, and there are

three main ones. The first approach prioritizes safety. This is where not the individual, but rather their

family and friends make decisions for them regarding mental health services. While this may decrease a

patient’s autonomy, it protects the individual and the people around them. Since this approach is an

extreme, it is important to analyze the other two approaches. The second approach ensures mental health

resources for everyone. This is beneficial because it allows you to get help no matter what. Since mental

health is very expansive, there are several kinds of resources that can be utilized by those who require it.

However, there are a series of challenges that are present with this approach. The first is that an

abundance of resources can be complicated for those trying to get help because they won’t be sure where

to go. While the first two approaches look at treatment and medication, the final approach looks at

plotting your own course. This means that instead of medication, people will instead make lifestyle

changes to improve their mental health. According to the APA, “therapeutic lifestyle changes” have

proven to be effective (Walsh). The benefits include that it decreases the overall reliance on medication,
and it is affordable and accessible. The challenges with this solution are that it may not be as effective for

extremely serious mental health conditions, which may require medication regardless.

As mentioned earlier, it is difficult to find a solution since mental health is so broad. There is one

approach that addresses that: Approach 2. There is a way to offer mental health resources to everyone,

and that is implementing specialists in primary care.

This solution was utilized internationally in Iran, Pakistan, and Zanzibar. In Iran and Pakistan,

village health workers received training in selected mental health topics (Jenkins). After they received

training, they were able to screen, assess, diagnose, and treat patients. Their work was monitored by

psychologists, who came to the villages once a month to check in on their work. In Zanzibar, training for

nurses takes four years, and the 4th year is devoted entirely to mental health (Jenkins). In Zanzibar, nurses

are the main workers within the healthcare industry, so this increases the presence of mental health

specialists in primary care. These places have shown to have good clinical and social outcomes with this

policy. This can be applied to the US- with patients, nurses spend more time with the patient, focusing on

their wellbeing. If the nurses in the US receive mental health training, they will be better equipped to help

their patients. An alternative of this policy is placing psychiatrists in primary care. In some ways, this

policy is already present in the US. When a patient goes to the hospital for a consultation, there will

usually be a psychiatrist present there that can respond. However, other healthcare providers, such as

clinics, may not have a psychiatrist present.

In order to instate a policy, it is important to analyze the logistics. For the primary solution,

information collection and adequate planning is required. In order for healthcare workers to be trained,

there must be data on what the priority topics are. Additionally, it is important to analyze the policy from

a population perspective. How can trained individuals serve an entire area? This connects back to data and

also how many trained individuals will be present in every area. In hospitals that are largely nurse-run,

many specialists will be available for the community.

It is also important to analyze the stakeholders involved in this policy. There are the patients-

however, their stake in this matter is not limited to the services they receive. We must also look at the
financial implications for them. If the government (whether it may be local or national) takes up the cost

for training, they might offset it by an increase in taxes or changing another government program (this

means that government officials are also stakeholders). If the cost is directly placed on the patients, they

will be paying a higher bill for the additional consultation. There is also the matter of transportation and

how they will receive the service. If trained specialists are present in every clinic and every hospital

across the country, then patients will have easier access. If trained specialists are limited to bigger

healthcare providers, such as hospitals, people in rural areas may find it difficult to receive the care they

need. Another group of stakeholders is healthcare providers. They have to receive training, and they

already work long hours in the day, so it will be difficult to find time for them to receive it. If training is

implemented in school, it will be easier for them to receive that knowledge. However, since priority

mental health topics may constantly be changing due to the data that is present, training will constantly be

evolving, so going through it one time may not be enough.

When thinking about mental health, it is important to think about all the groups of people who

may be involved. Mental Health is expansive and we must be able to provide resources for everyone to

feel safe and seen. By placing specialists in primary care, citizens are guaranteed to get help from people

who are trained, and that will allow them to live a better life moving forward.
Works Cited

Bergner, Daniel. “Opinion | a Major Problem with Compulsory Mental Health Care Is the

Medication.” The New York Times, 2 June 2023,

www.nytimes.com/2023/06/02/opinion/compulsory-mental-health-care-medication.html.

JENKINS, RACHEL. “Supporting Governments to Adopt Mental Health Policies.” World

Psychiatry, vol. 2, no. 1, Feb. 2003, pp. 14–19,

www.ncbi.nlm.nih.gov/pmc/articles/PMC1525068/#:~:text=Some%20common%20aims

%20for%20mental.

Panchal, Nirmita, et al. “The Implications of COVID-19 for Mental Health and Substance Use.”

KFF, 20 Mar. 2023,

www.kff.org/mental-health/issue-brief/the-implications-of-covid-19-for-mental-health-an

d-substance-use/.

Walsh, Roger. “Lifestyle and Mental Health.” American Psychologist, vol. 66, no. 7, 2011, pp.

579–92, https://doi.org/10.1037/a0021769.