Mental Health Screening in Primary Care

Mental Health In Primary Care

Mental health conditions affect approximately 61.5 million adults in the United States alone — roughly 23% of the adult population.¹ Despite these figures, for many people, their mental health conditions persist unrecognized and untreated. Even in affluent countries like the United States, nearly 50% of people with clinical depression are untreated.² Given national and global shortages of mental health providers and the stigma associated with receiving treatment, many people with mental health conditions do not seek specialty mental health services. Primary care providers (PCPs) have thus become the de facto mental health providers worldwide, identifying and treating some 70% of all patients seeking help for common mental health conditions like depressive, anxious, and substance use disorders.³ This figure is even more pronounced in rural areas, where mental health specialists are particularly hard to find.

In addition to identifying and treating many mental health conditions directly, PCPs work closely with patients to manage various health conditions with significant behavioral components. Examples of conditions that require substantial lifestyle modifications on the part of the patient include obesity, diabetes, chronic pain, and insomnia. The connections among behaviors, emotions, and physical health are so pronounced that in any given day, approximately three-quarters of a PCP’s schedule will consist of patients with clinical problems involving a significant behavioral or psychological component.⁴

These data underscore the importance of identifying and addressing mental health conditions in the primary care setting. The first step toward this objective is to develop and implement an effective screening process. A robust mental health evaluation is multi-modal and involves gathering data from various sources including clinical observation, self-report, assessment instruments, and extensive records review. Given significant time constraints, competing objectives, and other barriers in the primary care setting, however, such an evaluation is impractical. As a result, many clinics and providers have eschewed the process entirely. National data shows that only about 9% of primary care visits include depression screening — far below recommended levels.⁵ That figure is even lower for non-White and elderly patients, exacerbating existing health disparities in these groups. Screening of other mental health and chemical dependency conditions is similarly lacking, despite recommendations from the U.S. Preventive Services Task Force and other national organizations.

Even in clinics that do regularly screen for mental health and chemical dependency issues, the scope of these screenings is typically limited. First, it is often restricted to one or two conditions (e.g., depression, anxiety). Because many symptoms of mental health conditions are non-specific, misidentification is likely to occur when the screening process is too narrow. For example, inattention is a common complaint across various conditions (e.g., insomnia, anxiety, depression, post-traumatic stress disorder, attention deficit-hyperactivity disorder, substance use disorders). In the same way a physician would be expected to complete a thorough work-up of a fever to consider various differential possibilities (e.g., influenza, bacterial pneumonia, rheumatoid arthritis) before prescribing a treatment, an analogous process should be employed for inattention before a potentially addictive stimulant is prescribed. Likewise, if a PCP misidentifies unipolar depression based on the symptom of sadness in a patient with bipolar disorder, the PCP may inadvertently induce a manic episode by prescribing an antidepressant medication. These examples highlight how jumping to conclusions prematurely by failing to screen for other conditions can result in harmful consequences for treatable conditions that simply require a different intervention.

A related problem associated with overly restrictive mental health screenings is that co-morbidities may be overlooked. A significant body of research highlights the prevalence of co-morbidities in mental health. Roughly 50% of individuals with a mental health condition meet criteria for more than one such condition over their lifetime, often simultaneously.⁶ Similarly, nearly half of all people identified with a substance use disorder also have an identifiable mood or anxiety disorder. Although the mechanisms that underlie co-morbid psychological and substance use disorders are complex, there is general consensus that these conditions are not siloed. Rather, symptoms of one condition can, and usually do, impact another. As such, it is imperative that treatment is based on a comprehensive and accurate clinical impression that considers all relevant mental health and chemical dependency issues. This requires adequate screening mechanisms and triage processes in the primary care setting.

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Works Cited

1. Substance Abuse and Mental Health Services Administration. 2024 National Survey on Drug Use and Health (NSDUH). SAMHSA, 2025. 61.5 million adults (23.4%) with any mental illness.

2. Thornicroft, G., et al. “Undertreatment of people with major depressive disorder in 21 countries.” The British Journal of Psychiatry 210.2 (2017): 119–124.

3. Wang, P. S., et al. “Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys.” The Lancet 370.9590 (2007): 841–850.

4. Robinson, P. J., & Reiter, J. T. Behavioral Consultation and Primary Care: A Guide to Integrating Services. New York: Springer, 2007.

5. Office of Disease Prevention and Health Promotion. “Increase the proportion of primary care visits where adolescents and adults are screened for depression.” Healthy People 2030. U.S. Department of Health and Human Services. 9.1% of visits as of 2019.

6. Plana-Ripoll, O., et al. “Exploring Comorbidity Within Mental Disorders Among a Danish National Population.” JAMA Psychiatry 76.3 (2019): 259–270.

Related Resources

• Comorbid mental health screening — Why multi-condition assessment changes outcomes
• CPT 96127 FAQ — Brief emotional/behavioral assessment billing guide
• CPT 96130 FAQ — Psychological testing evaluation services
• CPT 96136 FAQ — Test administration by a provider
• CPT 96138 FAQ — Test administration by a technician
• CPT codes for psychological testing — Overview of the 2019 code changes
• Mental Health Parity Act — Your rights when payers deny claims

Frequently Asked Questions

Why is mental health screening important in primary care?

Primary care providers manage approximately 70% of patients seeking help for common mental health conditions, yet only about 9% of primary care visits include depression screening. Routine screening identifies conditions that would otherwise go unrecognized — often for years — allowing providers to intervene earlier and coordinate appropriate care.

What percentage of mental health conditions are managed by primary care providers?

Approximately 70% of patients seeking help for common mental health conditions — including depression, anxiety, and substance use disorders — are managed by primary care providers rather than mental health specialists. This figure is even higher in rural areas where mental health specialists are scarce.

How many adults in the United States have a mental health condition?

Mental health conditions affect approximately 61.5 million adults in the United States — roughly 23% of the adult population. Despite these figures, for many people, their mental health conditions persist unrecognized and untreated.

What is the depression screening rate in primary care?

According to Healthy People 2030, only about 9% of primary care visits included depression screening as of 2019 — far below recommended levels. Screening rates are even lower for non-White and elderly patients, exacerbating existing health disparities in these groups.

Why is single-condition screening insufficient in primary care?

When screening is limited to one or two conditions, co-occurring conditions are missed. Roughly 50% of individuals with a mental health condition meet criteria for more than one condition over their lifetime, often simultaneously. Narrow screening can lead to misidentification — for example, a patient with bipolar disorder may be identified only as having unipolar depression, leading to interventions that worsen their condition.

What conditions should primary care providers screen for?

At minimum, primary care screening should cover the conditions most commonly seen in general practice: depression, anxiety, ADHD, bipolar disorder, substance use disorder, and somatic symptom disorder. Multi-condition screening tools that evaluate several conditions simultaneously reduce the risk of missed comorbidities.

Can primary care providers bill for mental health screening?

Yes. CPT 96127 reimburses providers for brief emotional and behavioral assessment with scoring and documentation, per standardized instrument. As of 2026, the Medicare national average is $4.97 per unit with a maximum of 3 units per date of service. Any physician or qualified healthcare professional can bill this code — there is no specialty restriction.

How does mental health screening affect physical health outcomes?

Mental health conditions have significant behavioral components that affect physical health management. Conditions like obesity, diabetes, chronic pain, and insomnia all involve behavioral and psychological factors. Research indicates that approximately three-quarters of a primary care provider's daily schedule involves patients with clinical problems that have a significant behavioral or psychological component.

What barriers prevent mental health screening in primary care?

The primary barriers are significant time constraints, competing clinical objectives, and the impracticality of conducting a full multi-modal mental health evaluation in a primary care setting. As a result, many clinics and providers have eschewed the process entirely, despite recommendations from the U.S. Preventive Services Task Force.

Does the U.S. Preventive Services Task Force recommend mental health screening?

Yes. The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum persons, and screening for anxiety in adults under 65. These recommendations apply to primary care settings, yet screening of mental health and chemical dependency conditions remains lacking in most practices.