An increase in mental health care needs has led to primary care physicians navigating the complex challenges of mental health medication management
In recent years, the healthcare industry has seen a shift of mental health management from the specialist realm to primary care as mental health issues become more prevalent.
Between 2007 and 2017, the percentage of behavioral health-associated medical claims doubled, while outpatient spending on psychiatry grew by 40%. These trends have been exacerbated by the COVID-19 pandemic. RAND reports that spending on mental health services jumped 53% between March 2020 and August 2022 among people with employer-provided insurance. In that same period, use of mental health services grew by 39%. As these issues in mental and behavioral health continue to progress, primary care providers will need tools that support their ever-expanding roles in the health of their patients.
A shortage in mental health professionals is also impacting these challenges. Fewer than half of people experiencing mental illness in 2021 were able to access timely care. Those who struggled the most were people in rural areas, people covered by Medicaid, and underserved groups (non-English speakers, people of color, and LGBTQ communities).
This shortage has shifted much of mental health care challenges and mental health medication management to primary care providers, including one of the most complex areas of mental health medication management, cross-tapering mental health medications. Over 70% of primary care providers are writing an initial prescription for anxiety or depression for at least one patient a week. A full 85% are providing long-term mental health care for the same proportion.
The result is that these providers are expected to squeeze in complex mental health needs and mental health medication management tasks like cross-tapering on top of other responsibilities, including preventive care, medication history review, social determinants of health assessments, visit documentation, and health counseling.
The cross-tapering process explained
Cross-tapering is a process of switching a patient from one medication to another. Often used with antidepressants, it involves gradually reducing and stopping one antidepressant while simultaneously introducing and increasing the dose of a second. It most commonly involves the following steps:
- Assess patient history
- Determine tapering plan
- Monitor the patient closely
- Educate the patient on their treatment
- Adjust medications based on symptoms and provider observations
