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    By: Dr. Ana M. González Luna,
    Psy.D., LCSW


    Comprehensive health care, which includes mental health, is essential for improving a patient’s quality of life and satisfaction with healthcare services. While patients often visit their primary care physician to treat physical problems, it’s equally important to pay attention to their mental health as well.

  • Studies show that patients who receive comprehensive care for their physical and mental health needs are better able to manage their medical conditions and adhere to treatment.
  • In addition, this approach can reduce healthcare costs, as patients are less likely to need emergency care or hospitalization.

    • According to data from the Puerto Rico National Health Survey, in 2021, around 20% of elderly individuals on the island reported having some type of mental disorder, with a total of 69 suicides registered in 2021 for those over the age of 60. Depression and anxiety are the most common disorders in this population, and may be related to the loss of loved ones, financial problems, chronic illnesses and other stressors. Therefore, early identification of symptoms and their appropriate treatment are essential to promote patient wellness.

    This mental health scenario in our population confirms the need for primary care physicians to be trained to detect the signs and symptoms of mental disorders in their patients, and offer preventive counseling

    Some of these signs may include:

    • Mood changes
    • Trouble sleeping
    • Changes in appetite
    • Lack of energy
    • Difficulty concentrating
    • Performing daily activities

    Physicians can also use screening tools to identify patients who might benefit from a more detailed evaluation by a mental health professional, for example:

    • The PHQ-9 (Patient Health Questionnaire-9) is a tool that can be used to identify the presence of depression symptoms.
    • Online or in-person training sessions can also help one use these types of tools, and offer preventive counseling.

    It’s important to remember that mental health care is not limited to preventive screening and counseling.

    • Primary care physicians can help patients get specialized care when needed, for example;
      - A patient with anxiety or depression may benefit from a psychologist’s care, while a patient with schizophrenia may require a psychiatrist and an interdisciplinary team.
    • Some of the strategies mental health professionals use include drug treatment, cognitive behavioral therapy, occupational therapy, group therapy, and supportive therapy.
    • On the other hand, patients facing financial difficulties or social changes that impact their physical or mental health may benefit from counseling by a social worker.

    In some cases, prevention is the best strategy to prevent mental disorders. Healthy lifestyle advice, such as promoting regular physical activity, a balanced diet, reducing alcohol and tobacco use, stress management and seeking social support can be provided during the medical consultation. In addition, it’s essential that patients, especially the elderly, develop coping and resilience techniques to better manage the challenges of daily life.

    And because they are often a patient’s first point of contact with the healthcare system, primary care physicians in Puerto Rico play an important role in detecting and addressing their patients’ mental health needs. While there are many supportive resources that can be used for the proper management and prevention of mental health problems, at the end of the day, the physician’s collaboration with mental health professionals and social workers is the key to providing the comprehensive, personalized care patients need.

    References:

    1. Puerto Rico Department of Health. Analysis of Puerto Rico’s Mental Health Situation (2021). https://assmca.pr.gov/estadistica/Ao%20Fiscal%2020142015/Evaluaci%C3%B3n%20al%2 0Estado%20de%20la%20Salud%20-%20Salud%20Mental.pdf [assmca.pr.gov]
    2. Commonwealth of Puerto Rico Office of the Procurator for the Elderly. 2021 Annual Report. https://agencias.pr.gov/agencias/oppea/procuraduriaprogramas/Informacin/Informe%20 Anual%202021.pdf [agencias.pr.gov]"