Mental Health Care in 2026: Stigma, Substance Use, and Practical Opportunities in Primary Care

Mental health care in primary care extends well beyond medication selection and often reflects broader system-level constraints that shape patient outcomes. In an interview with Patient Care Online, Gus Alva, MD, medical director of ATP Clinical Research in Orange, CA, describes how ongoing challenges such as stigma, limited access to specialty mental health services, and unmet social needs continue to complicate care as clinicians move into 2026. He emphasizes that many patients attempt to self-manage symptoms through maladaptive coping strategies, including alcohol or substance use, which can worsen psychiatric and medical comorbidity and further strain primary care encounters. Alva highlights the importance of education—both for patients and clinicians—as a foundational opportunity to improve engagement and outcomes, noting that normalizing mental health conditions as legitimate medical issues can reduce delays in diagnosis and treatment. He also underscores the role of primary care physicians in recognizing when psychosocial stressors, housing instability, or substance use are driving symptom persistence, and when referral or coordinated, team-based care is necessary. Rather than framing these challenges as insurmountable, Alva points to pragmatic strategies such as harm reduction, patient-centered communication, and collaboration across care settings as meaningful ways primary care can improve outcomes even within constrained systems.

For more of our conversation with Alva, check out:

• Key Advances in Mental Health Research in 2025 for Primary Care
• Depression Screening in Primary Care: How to Keep Bipolar Disorder on the Differential
• Psychedelic-Assisted Therapies for Depression and PTSD: Current Evidence and Clinical Considerations
• Psychiatry in 2026: Emerging Therapies and Why Sleep Is Moving Up the Priority List