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1 I INTRODUCTION A Conference on Provision of Mental Health Services in Primary Care Settings was held April 2 and 3, 1979, at the National Academy of Sciences in Washington, D.C. The conference was organized by the Institute of Medicine, through its division of Mental Health and Behavioral Medicine. Support was provided by the Division of Mental Health Services Programs, National Institute of Mental Health, Depart- ment of Health, Education, and Welfare. The meeting was designed to examine the benefits as well as the potential disadvantages and difficulties in linking mental health services and primary care in a coordinated approach to health care. Specific conference objectives were to: o consider how linkage can take place between primary care and mental health services without causing additional costs or regulatory burdens, and without compromising the autonomy of the mental health system o identify potential risks of linkages between health and mental health toward an end of assisting the federal Government in developing realistic regulations, guidelines and evaluation procedures develop an agenda for future studies in health and mental health services research. The conference had both plenary and small group sessions, a structure that enabled presentation of major papers to all conference participants and discussion of particular issues in smaller invita- tional workshops. Appendix A lists the full conference agenda. David A. Hamburg, M.D., President, Institute of Medicine, National Academy of Sciences, chaired the plenary sessions. The first day presentations were keynoted by Herbert Pardes, M.D., Director, National Institute of Mental Health; Merle Cunningham, M.D., Bureau of Community Health Services, Health Services Administration, speaking on behalf of Edward Martin, M.D., Director, Bureau of Community Health Services; and Gerald L. Klerman' M.D., Administrator, Alcohol, Drug Abuse and Mental Health Administration. Michael Shepherd, M.D., Professor of Epidemio- logical Psychiatry, Institute of of Psychiatry, University of London, addressed the conferees at the plenary session opening the second

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2 day of the meeting. His paper "Mental Health as an Integrant of Primary Care" highlighted some key issues that were considered in the smaller workshop sessions held following his presentation. The papers presented at the plenary sessions are summarized in Section IV An integrated summary of the three invitational workshop discussions is contained in Section V. to attend the workshops. . . ~ . . Appendix B lists the participants invited The afternoon of the second day concluded with a pane' discuss' on, summarized in Section VI, on future directions in coordination of mental health services in primary care settings. Julius Richmond, M.D., Assistant Secretary for Health, Department of Health, Education and Welfare; George Lythcott, M.D., Administrator, Health Services Administration and Gerald Klerman, M.D., were the discussants. Five papers were commissioned by the Institute of Medicine speci- fically for this conference. An abstract of each of these papers appears in Section IV where major presentations are summarized. The full text of each is contained in Section VII. The design of this conference included an opportunity for pari- cipants to submit post-meeting comments on issues raised in the sessions. or on areas ~ ~ ~ _ that, in the writer~s opinion, need rurtner examination. These "postscripts" are included as Appendix C of this conference summary. Volume 2 consists entirely of a principal background paper for the conference, "Coordinated Mental Health Care in Neighborhood Health Centers," by Jonathan Borus, M.D. and colleagues. An earlier version of this monograph had been developed in 1977-78, for submis- sion to the President's Commission on Mental Health.