The field of medicine is ever-changing, and so are the recommendations for what screening tests physicians should put their patients through to provide the most benefit with the least harm.

In the near future, it’s possible you’ll hear questions from your primary care provider about your mental state as well as your physical health.

That’s the latest recommendation from the United States Preventative Task Force. Created in 1984, the volunteer panel of national experts in prevention regularly assesses what screening tests make the most sense for everyone.

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Studies have shown that screening helps identify people who are depressed, which could lead to earlier intervention and better care.   

In theory, it makes sense. People see their doctors for a variety of reasons, and to only treat their medical problems like diabetes, for example, but not the reason they don’t exercise, such as being too depressed to leave the house, well, that is not a recipe for success.

However, with each screening question that is asked, the ultimate question arises, what is going to be done if someone says “yes”? What are doctors going to do if someone suddenly ackowledges being clinically depressed?

As a primary care provider, I can prescribe medicine, but I am not qualified to provide psychotherapy. Studies have been done and show a synergistic effect of doing both when treating depression. In addition, prescribing medication alone for those 18-29 has been associated with an increase in suicidal behaviors, which are best handled by a psychologist or psychiatrist, or both.

Primary care providers can be the gateway to seeing other specialists, but only if we have those other professionals available. Do we have enough psychiatrists and psychologists in Hawaii to handle this potential influx of patients?

Statistics show that on average, 6.7 percent of the U.S. adult population meets the criteria for major depression. In Hawaii, with an approximate population of 1.4 million, 78 percent of whom are over the age of 18, that would mean more than 73,000 people.

Psychiatrists handle not only depression, but also other major medical illnesses, such as anxiety, obsessive compulsive disorder, bipolar disorder, schizophrenia, and many more. In their average day, which is comprised of seeing approximately 10 patients, will they have space to take on new cases?

According to a November 2014 study done by Mental Health America, Hawaii ranks last in the percentage of adults with mental health conditions receiving treatment at only 26.5 percent. How will Hawaii be able to handle the greater demand on the psychiatrists and psychologists as more people are identified who need help?   

It’s hard to recruit doctors to the islands, and we currently have a shortage of providers. But it’s even harder with the significantly lower rates of reimbursement for mental health care compared to primary or subspecialty care.

According to Dr. Mark Stitham, board certified forensic, adult and child psychiatrist, the rates for reimbursement have definitely not kept up with inflation.

“HMSA has frozen allowable fees for over 20 years. In 1988 from HMSA, I was allowed to charge $135 per hour. In 1993, the same. In 2010, even less at $133,” he wrote in an email. “Today, $135 would have to be $272 to have the same purchasing power. Meanwhile, of course, MD costs for labor, rent, etcetera, have gone up. For many providers the decision has been made to stop participating with the major health insurances in the state.”

Stitham is not alone. Although insurance coverage for mental health services has improved slightly, it is still not enough to cover inflation and the cost of running an office.

A quick call to HMSA’s behavioral health line revealed that it has a limited list of available psychiatrists for its Medicaid population, much fewer than for its commercial patients. The average waiting time is one to two months. Why the lack of openings? It comes back to the low rates of reimbursement from both federal plans such as Medicare and Medicaid, along with our local insurance carriers. Rates may have slowly risen, but not enough to guarantee that everyone with a mental health issue is treated.

The U.S. Preventative Task Force has stated that if no behavioral health support plan is in place, it is not a recommended to screen all adults for depression.

Basically, it’s a new version of don’t ask, don’t tell, because there aren’t enough people to help. But should we eliminate such an important part of medical care just because we may not have enough professionals to handle the numbers of people who have mental health needs? Reimbursement rates in Hawaii and nationally need to rise in order to adequately pay psychiatrists, psychologists and others for their level of training and expertise.

With the release of the latest task force guidelines, it only seems fair that rather than ignoring mental health issues in areas where there aren’t enough providers, the “rulers” of Medicare and Medicaid should take a serious look at putting their money where their mouths are. Other insurance carriers are bound to follow suit.

The end result will be greater mental and medical health for all of us.