Many Clinicians Feel Unprepared to Treat Behavioral Health Conditions

Despite feeling lack of preparedness, most clinicians report willingness to provide substance abuse or mental health services for patients.

Clinicians are poorly prepared to screen and treat patients with substance abuse and behavioral health disorders, a recent survey found.

About 65 million Americans will experience a mental health or substance use disorder in their lifetime, which raises risk of disease and mortality as well as increases healthcare costs. Integrating behavioral health services into routine care creates opportunities for clinicians to assess mental health and substance abuse, then intervene if appropriate.

"Healthcare professionals responding to this survey report not feeling adequately prepared to address the needs of patients with potential substance use and mental health problems. Such lack of preparedness means that patients will go undetected for common behavioral health problems for which screening measures and intervention models exist and can be feasibly administered in most healthcare settings," the survey authors wrote.

The survey has several key findings:

• 57% of clinicians reported not feeling adequately prepared to screen patients for substance abuse or mental health disorders
   
• 64% of clinicians reported not feeling adequately prepared to use motivational interviewing to boost patients' desire to change behavior or seek help
   
• 62% of clinicians reported not feeling adequately prepared to work with patients to craft an action plan
   
• 84% of clinicians reported willingness to provide substance abuse or mental health screening, brief interventions, and treatment referrals to patients

The survey collected data from nearly 700 healthcare professionals from more than 50 organizations.

Preparing clinicians to provide care
 

Addressing prejudice and improving behavioral health education are the keys to better preparing clinicians to care for patients with substance abuse problems and mental health disorders, Deborah Finnell, DNS, CARN-AP, FAAN, a faculty consultant at Johns Hopkins University's School of Nursing in Baltimore and co-author of the survey, recently told HealthLeaders.

"It is essential that clinicians recognize their biases toward this population that is vulnerable and among the most stigmatized globally. My 2018 publication in Substance Abuse reviews the neural pathways of disgust, bias, prejudice, and discrimination that fuel stigma. A non-judgmental approach to this population is key to developing a trusting relationship," Finnell said.

Education about established measures for screening is crucial, she said. 

"These measures need to be those that have been established through research, for the intended purpose and population, and administered in the way they are intended. For example, the CAGE questionnaire is useful for detecting persons with an alcohol use disorder, yet the Alcohol Use Disorder Identification Test (AUDIT) is a screening tool that can be used to identify the level of risk related to alcohol—from low risk to moderate risk to severe. Thus, the AUDIT is a sound measure for universal screening in populations."

Once a risk is identified, then clinicians need to know how to intervene effectively, Finnell said.

"Motivational interviewing skills are invaluable for promoting behavior change—whether that is encouraging patients to take medications consistently or encouraging patients to consider reducing the amount of alcohol consumed. Clinicians also need to know when and how to refer an individual who could benefit from specialty treatment."

Seizing primary care opportunity
 

Some clinicians may fear upsetting patients or otherwise abdicate their role in addressing substance abuse as part of primary care to specialists. The barrier may be their own attitudes and perceptions toward the population and fears about their own lack of knowledge about screening, brief intervention, and referral to treatment (SBIRT), Finnell told HealthLeaders.

"As this clinical set of strategies is implemented in primary care, then patients with low and moderate risk can be managed in that setting while those who could benefit from specialty treatment can—and should—be referred to specialists."

The SBIRT technique can help provide patients with timely treatment, she said. "SBIRT is about preventing the progression of risks that can be detected early with evidence-based screening measures, interventions, and treatments provided in primary care at the same time as the patient visit."