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Behavioral Health Care Integration in Obstetrics and Gynecology

Medscape – MedGenMed Ob/Gyn & Women’s Health

Jean M. Cassidy, LCSW, BCD, Virginia A. Boyle, PhD, Hal C. Lawrence, MD

Abstract and Introduction

Depression, anxiety, and somatoform disorders are 2 to 3 times more prevalent in women than in men. Since the advent of managed care and other pressures on the healthcare delivery system in the United States, there has been a notable diminishment of services and service funding for treatment of mental health conditions, whether they are temporary, transitional, or chronic. As a result of this trend, we have seen an increase in the number of patients seeking help for emotional and mental health concerns from their family doctors or, in the case of women, from their obstetrician-gynecologists. We have also found that emotional and mental health problems are often converted into physical symptomatology that carries fewer stigmas and is often viewed as easier to treat. Many women use their obstetrician-gynecologists for primary care, particularly during their reproductive years. Provision of behavioral healthcare is critical to health maintenance for many of these women. Barriers to the integration of behavioral healthcare into obstetrics and gynecology practice need to be understood and systemically addressed.

Changes in strategies that meet the healthcare needs of the general public have been significant since the advent of managed care and other pressures on the healthcare delivery system in the United States. Physicians and healthcare providers are expected to limit the time they allocate to each patient. Yet, the number of diagnostic categories has increased, and the number of diagnostic steps leading to identification of many diseases has also increased. Of course, this offers a myriad of treatment options and, hopefully, improved outcomes for the patient. However, in the area of mental healthcare, there has been a notable diminishment of services and service funding for treatment of mental health conditions — whether they are temporary, transitional, or chronic.

As a result of this trend, we have seen an increase in the number of patients seeking help for emotional and mental health concerns from their family doctors or, in the case of women, from their obstetrician-gynecologists. We have also found that emotional and mental health problems are often converted into physical symptomatology, which carries fewer stigmas and is often viewed as easier to treat.

A well-accepted role of the family practitioner has been that of primary care provider. Provision of primary care services has included, albeit somewhat gingerly at first, the identification, treatment, and medical management of emotional and mental health problems. As far back as 1965, it had been suggested — even recommended — that obstetrician-gynecologists take on the added responsibility of primary care provider for women.[1,2,3] In fact, for some time, health advocates and academicians have proposed that understanding the relationships between the medical, psychological, psychosocial, and socioeconomic factors of women’s health is basic to the delivery of adequate healthcare for women.[4,5,6]

The purpose of this article is to emphasize the need for the inclusion and integration of services that identify, treat, and medically manage behavioral health issues in the practice of obstetrics and gynecology. The second purpose is to highlight some of the research and opinion regarding the integration of behavioral healthcare into the routine medical practice of obstetricians and gynecologists. A third purpose is to acknowledge some of the problems hindering the integration of these services and to suggest ways some of these barriers might be overcome. By the term “behavioral healthcare,” we mean the healthcare provider’s assessment and medical management of those psychological and sociological influences that affect the patient’s thinking, perception, decision-making ability, relationships, and daily functioning as they relate to the patient’s physical health.

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SheVille Team

We are a one-of-a-kind magazine that provides local, regional, national and international information about women’s lives and education, performing and visual arts and writing, the environment, green living and sustainability and regional Western North Carolina business, people and events. “Villages preserve culture: dress, food and dance are a few examples. As villages grow in population and turn into towns, local cafes make way for large American chains. Handmade leather sandals are discarded for a pair of Western sneakers. Due to its small size, a village fosters a tight-knit sense of community. Justpeace.org explains the meaning of the African proverb, “It takes a village,” by stating that a sense of community is critical to maintaining a healthy society. Village members hold a wealth of information regarding their heritage: they know about the ancient traditions, methods of production and the resources of the land. When villages become dispersed or exterminated in times of war, this anthropological knowledge disappears. Large cities are not as conducive to growing and producing foods such as fruits and vegetables. Villages, on the other hand, usually have ample amounts of land and other resources necessary for growing conditions.” The Importance of Villages by Catherine Capozzi Our Mission SheVille.org provides readers with information important to women’s lives and well-being. We focus primarily on the areas of education & health, business & finance, the arts & the environment. We are particularly interested in local & regional resources, organizations & events.
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