A patient with the clear capacity to understand, or one who clearly does not have capacity, does not need a psychiatric evaluation. However, a mental health evaluation can help in questionable cases to further assess capacity. For example, suicidal patients lack the capacity to understand as active suicidal ideation is a sign of impaired judgment. Or, a patient may have a history of bipolar disorder making it impossible for him/her to manage his financial decisions.
However, the same individual might still be considered to have the competence to refuse treatment.
Most patients seen in primary care will experience one or more psychological or behavioral health problems during their lifetime. Although some patients need specialized care, primary care physicians should not discount the potential impact of taking time during office visits to consider brief behavioral interventions with patients who struggle emotionally or face life crises. Actions such as instilling hope, and using active listening can be powerful.
Physicians can also greatly influence patient willingness to follow through with referrals. With mental illness, however, the limits of primary care physicians’ roles are less clear. What is correct in the case that a patient is hearing voices or walks into the office and announces that he/she has decided to kill him/herself? What about a lawyer who’s having trouble meeting deadlines and asks for medication for attention-deficit disorder? Or the patient whose therapist told her to see her PCP about prescribing an antidepressant? Or the police officer who, after a shoulder injury, is trying to shake an Oxycontin addiction? The request for treatment in these cases is primarily due to a level of comfort with primary care physicians and lack of access to a psychiatrist.
Over a third of all mental-health care in the U.S. is now provided by primary-care doctors, nurse practitioners, pediatricians, and family practitioners, often because there are not enough practicing psychiatrists, thus, this burden falls on primary caregivers.
