Taylor Locke was filling out an intake questionnaire during a routine visit with a primary care doctor last year when they realized something was off.
Little interest or pleasure in doing things? Check. Feeling down, depressed or hopeless? Yes, very much so.
“I’m a lot farther from my base line than where I want to be,” in terms of mental health, Locke, 24, thought at the time.
So when the doctor asked how things were going, Locke worked up the courage to reply honestly: “Not great.”
Locke, who uses they/them pronouns, lives in Troy, N.Y., where it can take months to get off the wait list to see a psychiatrist in person. So their primary care physician offered to prescribe sertraline, an antidepressant that had been helpful to Locke in the past.
“I had no idea that a P.C.P. could do that,” said Locke, who was struggling with seasonal depression and post-traumatic stress disorder, and had gone off the drug because of an earlier lapse in insurance.
As the end of the year approaches and patients try to squeeze in last-minute appointments, doctors and mental health advocates say it’s important to think about mental well-being in addition to physical health. Seeking out a mental health expert if you don’t already have one isn’t always necessary. Instead, experts suggested asking yourself, and your primary care doctor, a series of questions to gauge your mental state and the potential need for follow-up care.
While the idea of an annual behavioral health exam hasn’t yet caught on in the United States, a handful of states, including Massachusetts, Connecticut and Colorado, have passed legislation requiring insurance plans to cover mental health checkups, just as they would annual physicals, with no cost sharing.
“It’s more than just screening,” said Cody Hostutler, the clinical director for behavioral health integration at Nationwide Children’s Hospital in Ohio, who has backed a similar bill in his state. “If we do it well, it’s really an opportunity to support resilience and promote wellness.”
The idea is to catch issues before they become a crisis, to develop greater self-awareness and to learn more about which resources are available to help you stay mentally healthy over time, Dr. Hostutler said.
Family doctors often screen for unhealthy alcohol or drug use, depression and anxiety, following screening guidelines set by a task force appointed by a federal government agency. If you’re given a questionnaire, it’s important to answer honestly, Dr. Hostutler said.
But doctors are not necessarily required to follow those guidelines, so you may not have discussed these topics before with your primary care physician.
In that case, “I would encourage you to bring it up,” said Dr. Kisha N. Davis, president of the American Academy of Family Physicians. You can even schedule a visit especially for this purpose, rather than trying to squeeze it into an annual physical, she suggested, but in most states this will not be exempt from cost-sharing.
There are many ways to initiate the conversation, Dr. Davis said. For example: “I’ve been feeling more stressed, and I’d like to explore that.” Or, “I know we usually focus on my physical health, but can we also check in on how I’m doing emotionally?”
Your doctor might refer you to a mental health professional who can provide one-on-one therapy or suggest a support group. Alternatively, you might discuss sleep, exercise, mindfulness strategies, diet or whether to take a psychiatric medication. Most antidepressants and anti-anxiety medications in the United States are prescribed by primary care doctors.
For patients 65 and older, a short memory assessment for cognitive impairment should be included, as well, Dr. Davis said, and Medicare will pay for this during the annual wellness visit. A recent study found that annual wellness visits play an important role in increasing the prescription of medications for dementia.
“Mental health care isn’t just about treating illness, it’s about maintaining wellness,” she added.
To prepare for the visit, it’s important to notice changes in your emotional well-being just as you would pay attention to physical symptoms, said Dr. Christine M. Crawford, the chief medical officer for the National Alliance on Mental Illness.
For example, she suggested asking yourself, “Have I been more irritable and short with people?” Or “Am I feeling more emotionally disconnected than usual?”
If you’re curious about your symptoms, you can use online screening tools like the ones offered at Mental Health America or contact the NAMI HelpLine for emotional support and resources.
When you’re ready to make an appointment, the National Institute of Mental Health offers tips for talking with a health care provider about your mental health.
Taking a moment to reflect on your emotional well-being “is something that we are not trained to do,” Dr. Crawford said.
But letting smaller problems go unaddressed can eventually interfere with your ability to do the things you need to do day to day, “just the same way as if your leg were hurting,” she added.
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