Collaborative care—slow. Referral to a psychiatrist—even slower.

As new strategies aim meet the unprecedented mental healthcare needs of this country, a fact remains: Psychiatric care is primarily administered in primary care settings.

A shortage of psychiatrists not only delays quality psychiatric care for all patients, but introduces more complex psychiatric patients into primary care settings. Psychiatric comorbidity and polypharmacy becomes more typical. Medical comorbidity and non-psychiatric polypharmacy complicates the provision of psychiatric drugs by introducing potentially dangerous drug-drug interactions.

In a milieu where clinic visits are shortening, patient panels are lengthening, but medicolegal risk as palpable as ever, PCPs are tasked with managing antipsychotics in obese patients, lithium in patients with hypothyroidism and declining kidney function, SSRIs in adolescents amidst a black box warning for suicide, and a looming sense of risk in managing five psychiatric drugs in a frail and medically complex patient.

Current models that attempt to address this issue (e.g. collaborative care, behavioral health carve-outs, telepsychiatry) fail to meet the urgency of day-to-day medication treatment decisions that PCPs manage—situations that are not quite “refer to local ED” material, but where waiting 3-4 days for collaborative care psychiatrist to coordinate with BHM is dangerously inadequate.

At Psychopharmacology on Demand, we deliver expert case-based educational content within 24 hours, via text/phone and video to nurture that “subacute” decision tree.