In a primary care psychosocial workflow, what are the recommended steps after an initial positive screen?

• A. Conduct targeted assessment (PHQ-9, GAD-7), assess suicide risk, refer for therapy/psychiatry, arrange follow-up.
• B. Ignore the positive screen and recheck in a year.
• C. Refer only for physical health evaluation.
• D. Immediately hospitalize without assessment.

Answer: (A)

When a positive mental health screen appears in primary care, the next steps focus on understanding the shape and safety of the issue and then linking to appropriate care, followed by planned follow-up. Begin with targeted assessment using validated tools like the PHQ-9 for depression and the GAD-7 for anxiety to gauge symptom severity, functional impact, duration, and prior treatment history. At the same time, conduct a suicide risk assessment by asking directly about thoughts of self-harm, intent, planning, and means, and develop a safety plan if there are any safety concerns.

Based on what you find, refer to therapy or psychiatry as appropriate, and consider a stepped-care approach that may include psychotherapy (e.g., CBT, problem-solving therapy) and, when indicated, pharmacotherapy, with care coordinated through collaborative or integrated care. Arrange follow-up to monitor symptom change, treatment adherence, and side effects, reusing the screening measures to track progress over time.

Skipping assessment and safety planning, ignoring the mental health concern, or immediately resorting to hospitalization without evaluation are not appropriate approaches in this context; the goal is to assess, ensure safety, connect to appropriate treatment, and monitor progress.