Transmuted Internalizations has an important post on blog carnival on mental health treatment in primary care.
Primary care physicians may be exacerbating patients’ problems by “treating” normality and introducing people to potentially very problematic side effects. Really, this is pitiful and tragic: imagine a patient who comes to his doctor’s office complaining of “stress” or “sadness” about a current relationship, who leaves with a prescription for an SSRI. That SSRI then causes sexual dysfunction and the patient’s problems multiply. What to do? Refer. Primary care physicians maybe should not be the gatekeepers when it comes to deciding who should get mental health care. Maybe primary care doctors should refer directly to a psychologist or a psychiatrist. There are more serious problems here than just side effects. Misery is the most creative force in our lives. Medicating the impetus to change is a sure way to turn an acute problem into a chronic one. Every medical clinic should have referral sources who can advise them about mental health care. Psychiatrists are in short supply in many places. A seasoned competent psychologist or clinical social worker could be a valuable consultant to a primary care physician.