A Family Physician on When to Manage Depression in Primary Care—and When to Refer

Primary care physicians are often the first to identify and manage depression, but recognizing when a patient’s risk requires immediate referral is critical. In this video, Teresa Lovins, MD, a family physician and and owner of Lovin My Health DPC, in Columbus, Indiana, explains how clinicians can distinguish between patients who can be managed with safety planning in primary care and those who need urgent connection to mental health services.

The following transcript has been lightly edited for style and clarity.

Patient Care®: For some individuals with depression, being followed in primary care is great for medication as well as for follow-up. But suicidal depression and situational depression are really different. Do you think family physicians and other primary care physicians are well enough trained to discriminate who needs to be referred and who they can manage?

Teresa Lovins, MD: Well, I think yes, we are trained well enough to understand which patients need that additional assessment. I think often patients who are suicidal don’t have a plan. They don’t have a way for it to happen. For those patients, creating a safety plan can be done by the family physician. But for patients who have a plan, a motive, and a way to carry it out, it’s very important that we get them involved with a mental health therapist and the mental health system as best we can for them.