Resources Accelerate Mental Health Diagnosis and Treatment

In recognition of Mental Health Awareness Month, HQI is sharing tools and resources to help clinicians screen for substance abuse and mental health issues. According to a report from The Commonwealth Fund, more than 40% of all American adults will experience a substance abuse or mental health event during their lifetime.  Twenty percent of Medicare beneficiaries reported depression and alcohol abuse as the most common mental health issue they face.  The combination of mental and physical conditions may complicate the diagnosis and delay treatment for mental health condition. Often, patients seek treatment for a physical condition only to discover an underlying mental health issue.

Emergency departments (EDs), primary care providers and clinics, often become the first line of treatment due to easier access, or established patient-provider relationships.  Unfortunately, these providers may lack the necessary time, resources or training to diagnose, manage or make mental health referrals.  In fact, 60 to 70% of all adult patients are discharged without appropriate mental health information or resources.  Among the Medicare population, two out of three do not receive behavioral treatment or referral, in part due to a shortage of mental health providers or insurance barriers (Miller and Farley, 2015, Seamlessly Integrating Behavioral Health).  These are troubling statistics considering untreated behavioral illness cost the healthcare system $57 billion a year, impact management and treatment of comorbid conditions, and increase readmissions.

What can primary health and ED providers do to improve care?  It is important for you to understand the connections between mental health and physical symptoms and the impact on overall health. Early recognition, timely treatment and referral are imperative.

Several evidence-based tools will help you quickly assess and diagnosis of mental health issues such as depression and substance abuse. Tools such as AUDIT, NIDA or CAGE-AID can determine whether an individual is at risk for or has an actual substance abuse condition.  The PHQ-2 screens for depressive moods, while the PHQ-9, a more comprehensive tool, screens, diagnoses, monitors and measures the severity of the depression.  The evidence-based SBIRT, screens for high risk behaviors and provides interventions to reduce and prevent health consequences, diseases and incidents of injuries.

The tools are appropriate for any setting and can be deployed quickly. In 2017, Medicare implemented a new Medicare Physician Fee Schedule allowing primary care and ED providers to bill for these services under the integrated care management program. The integrated care management program would allow better access for providers and patients to behavioral health resources, while allowing them to be compensated for their effort.

Although the challenge for primary care providers, clinics and EDs seems daunting, resources are available to assist in providing a better quality of care to individuals who have difficulty recognizing their medical conditions.


  1. Alcohol Use Disorders Identification
  2. National Institute Drug Abuse screening tool
  3. CAGE-AID Questionnaire
  4. Substance Abuse and Mental Health Service Administration
  5. PHQ-2. Patient Health Questionnaire, 2 questions only
  6. PHQ-9. Patient Health Questionnaire, 9 questions only
  7. Screening, Brief Intervention and Referral to Treatment
  8. Provides a vast resource list for all ages
  9. Substance Abuse and Mental Health Service Administration Fact Sheet



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