Incorporating mental health services into obstetrical and gynecology practices

Mental health conditions affect nearly 24% of the general adult population and are the primary reason for 5% of all office visits to primary care providers. Rates are higher for women than men, for minorities than whites, and for those living in poverty. For these reasons mental health disorders are among the most commonly encountered conditions in women's health care. However, community-based mental health resources are few. Wait times of 3 months or more for appointments with mental health providers are not usual, particularly for inner city and rural women, non-English speakers, and those insured by Medicaid. To improve the mental health of women in their care, primary care and OB-GYN providers must be comfortable in identifying and managing common mental health conditions such as anxiety and depression. A common disincentive to screening for mental health problems has been the paucity of referral resources once problems have been identified. Management of mental health conditions in primary and obstetric care will facilitate timely identification of mental health disorders with predictable benefits for both parents and their children. The co-location of mental health services with medical care alleviates many barriers to access and reduces potential stigma and resistance to mental health referral. This presentation will describe the protocols developed by a team of medical and mental health providers at an inner city community health center which has increased the availability and quality of mental health services including emergency intervention. These protocols expand upon the Macarthur Initiative on Depression & Primary Care model.