Project ECHO: Can We Teach Physicians to Better Diagnose Mental Disorders?
I’m conflicted about the announcement of Project ECHO’s expansion last week. The ECHO Institute was founded by the Robert Wood Johnson Foundation, the GE Foundation and the University of New Mexico Health Sciences Center to help primary care physicians do a better job with common, chronic condition diagnosis and treatment via Project ECHO.
On Friday, they announced a new initiative focusing on mental health treatment. The new effort will involve having academics train primary-care physicians to strengthen and better coordinate their mental health care.
It’s the right focus, because family doctors and general practitioners prescribe the majority of antidepressants in this country, and are often the first-line professional to see a patient who may have a mental health concern.
But then the director of Project ECHO, Sanjeev Arora, spoke.
According to Politico, this is what he said:
Primary-care providers “don’t have the expertise to make the right diagnoses” for mental disorders, said Sanjeev Arora, director of Project ECHO and professor at the UNM Health Sciences Center. “They see this enormous difficulty, but they don’t have access to any psychiatrists,1 so they don’t know how to get that expertise.”
While it’s partially true that many physicians don’t have the “expertise” to make the right diagnosis, they actually do a pretty good job of at least recognizing mental health concerns. Throw in easy-to-use and -score screening measures, and physicians have a pretty good set of tools already. Some use them, but most don’t.
The first problem isn’t making even more tools and resources available to primary care physicians. The problem is getting them to use them regularly, and incorporate them into their ordinary practice.
The second problem is one of followup. If, by and large, physicians already are making the appropriate referrals to mental health professionals when they see their patient may benefit from specialized mental health treatment, who’s doing the followup?
Unfortunately, it’s usually not the physician’s office. Patients often don’t followup with mental health treatment referrals.2 Unless that changes — someone is there to help a patient understand the benefits of getting care and treatment for their mental health concern and makes sure that they do — all the access to additional “expertise” isn’t going to help much.
So most physicians already have access to a multitude of quick screening tools that they can provide their patients. They also usually have access to a select list of trusted mental health professionals they refer to and trust, too.
What Project ECHO is essentially adding is a case conference — via videoconferencing — for physicians:
Primary-care doctors participating in the project will meet once a week with academic health specialists from UNM by video conference. The doctors will be able to discuss a range of issues that they’ve encountered from patients with complex mental health needs and draw from the academics’ expertise.
Which is a great idea, except for the use of academics instead of fellow clinicians.3 I assume they’re going to use academics who actually see real patients too, because otherwise this isn’t going to be very helpful in the long run. Researchers are really good at what they do — but usually dealing with the complexities and real world challenges of individuals isn’t among their expertise or usual skill-set.
I think it’s fantastic if a physician could have case conferences with mental health experts — which is something that, honestly, they should already be doing as a part of any modern, holistic, multi-disciplinary practice. The fact that many physicians (most?) don’t have a multi-disciplinary practice that incorporate and embrace mental health professionals is a shame — and where the real effort should be focused on expanding.
If Project ECHO can help physicians realize they should be doing this, then it’s a win-win for everyone.
Read more: New project addresses mental health care gap
- And last time I checked, a lot of different mental health professionals — not just psychiatrists — have expertise in diagnosing mental disorders. Psychologists, for instance, come to mind. [↩]
- Ehrenreich MJ, Robinson CT, Glovinsky DB, Dixon LB, Medoff DR, Himelhoch SS. (2012). Medical inpatients’ adherence to outpatient psychiatric aftercare: a prospective study of patients evaluated by an inpatient consultation liaison psychiatry service. Int J Psychiatry Med., 44, 1-15. [↩]
- Because most academics often don’t see patients — given that they’re, well, academics. [↩]
Grohol, J. (2018). Project ECHO: Can We Teach Physicians to Better Diagnose Mental Disorders?. Psych Central. Retrieved on April 4, 2020, from https://psychcentral.com/blog/project-echo-can-we-teach-physicians-to-better-diagnose-mental-disorders/