Letter to the Editor: What Are Orthopaedic Patients’ and Clinical Team Members’ Perspectives Regarding Whether and How to Address Mental Health in the Orthopaedic Care Setting? A Qualitative Investigation of Patients With Neck or Back Pain

To the Editor,

I read with interest the recent article published by Cheng et al. [4] showcasing both patients’ and clinical team members' perspectives on addressing mental health in the orthopaedic setting. The article demonstrates that our patients want their mental health issues to be addressed [4]. In recent years, there has been a growing body of evidence showcasing not only the high prevalence of mental health disorders in those undergoing orthopaedic procedures but also how frequently those individuals are disappointed with their results of treatment, whether because of persistent pain or functional limitations [1, 2, 5, 7-9]. As a result, institutions and funding bodies have demonstrated a newfound interest in further understanding this relationship [6].

While appropriate mental health screening and subsequent referrals from orthopaedic surgeons to outpatient mental health professionals would help diminish the burden, the demand for psychiatrists is greater than the available supply of mental health professionals [12]. To increase the number of mental health professionals, the United States Congress provided grants and technical assistance to implement the Collaborative Care Model in the primary care setting [11]. A typical collaborative care team is led by a primary care physician (PCP) and includes a designated trained behavioral health manager. Beyond PCP offices, this model can be incorporated in specialty clinics, like orthopaedic surgery clinics. The trained behavioral health specialist could then conduct standardized screenings in patients like the Patient Health Questionnaire for depression and provide preliminary treatment. Patients would then be discussed among the behavioral health specialist and psychiatric consultants to see if further psychiatric care is need [3]. Thus, this model not only provides immediate mental health care in the orthopaedic care setting but also provides appropriate triage to psychiatrists.

At the trainee level, there may be opportunities for residency programs to be more involved in the collaborative care model. Programs can consider implementing collaborative care clinics between departments, such as psychiatry and orthopaedic surgery. Early orthopaedic surgery resident exposure to mental healthcare can help them incorporate mental health assessments and mental health outcome tools into their future practices. Similarly, mental health professionals can glean additional insight into different subsets of patients, in this case, those contemplating orthopaedic surgery.

In summary, it is clear that orthopaedic surgeons have an opportunity to improve the emotional and social health of patients with musculoskeletal problems, but we are limited in supply of mental health professionals. The establishment of collaborative care models in surgical clinics can help start the process of providing immediate mental health care while also reducing the current referral burden among psychiatrists. Going one step further and implementing this model at the trainee level, we can also broaden the knowledge and experience of orthopaedic surgeons before they start their practice.