Mental Health Services in General Health Care A Conference Report, Volume I (1979) / Chapter Skim
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II. Background and Overview
II. Background and Overview
Pages 3-14
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1/ In addition to those with identifiable mental disorders, a great many patients seen in primary care settings have significant emotional or behavioral problems expressed as somatic symptoms or personal distress. The onset of physical illness often is precipitated by psychosocial stress or elicits maladaptive behavioral responses.
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There are increased emphases on social and behavioral sciences in medical curricula, promotion of primary care residency training programs with psychiatrists and other mental health specialists helping in the design and collaborative teaching arrangements, and development of neighborhood health centers and pre-paid health plans with psychiatric components. The President's Commission on Mental Health in its report submitted to the White House in April, 1978, emphasized a need to strengthen the working alliance between mental health and the general health care system: General health care settings represent an important resource for the mental health care in the community.
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consultation directed toward altering behavioral patterns that increase the risk of physical illness; collaborative treatment with non-psychiatric health care practitioners for those patients with combined physical and mental illness; and d) training non-psychiatric physicians and other health rare personnel to enhance their skills in the treatment of patients with relatively mild emotional disorders.
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Definitions of Primary Health Care and Mental Health Services In the 1978 Institute of Medicine report, "A Manpower Policy for Primary Health Care," primary care is defined as "accessible, compreprehensive, coordinated, and continual care provided by accountable providers of health services." _/ The five essential attributes of primary care as it should and could be practiced in the United States today were described as follows: (1) Accessibility of care refers to the provider's responsibility to assist patients or potential patients to overcome temporal, spatial, economic, and psychologic barriers to health care; i.e., to promote the availability, attainability, and acceptability of services provided.
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patient fear of stigma associated with psychiatric treatment; 2) the generally high cost of psychiatric treatment, limited private insurance coverage, and the major portion of public funds spent on inpatient care, particularly long-term institutionalization; and 3)
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, is a system in which subscribers pay a prearranged amount for an established set of medical services, which may or may not include mental health care. Physicians delivering prepaid health care are usually salaried.
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Identification and Management of Mental Health Problems in Primary Care Settings Although many patients with disorders that are both distressing and disabling seek primary care, it appears that primary care providers identify only a limited number of such patients who could benefit from specialty mental health care. A small segment of the adult primary care population may be utilizing medical services at high levels in an effort to remedy their undetected chronic psychiatric disorders.
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Although definitions of psychotherapy vary, 60 to 80 percent of patients with recognized mental disorder reportedly receive such therapy in some form from their primary care physicians. However, such therapy occurs in only 22 percent of the patient visits, and the difficulty of conducting formal psychotherapy due to time constraints in primary care settings are cited frequently.
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Mental health insurance also more frequently includes deductible and co-insurance requirements than do plans for medical illness. Some evidence suggests that adequate coverage for treatment of mental disorders within primary care settings and by primary care physicians as well as mental health professionals may lead to increased utilization of mental health services and a decrease in the utilization of general medical services.
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3) The common assumption that mental health care and physical health care services can be evaluated separately may be inaccurate if they are as integrally related as are mental and physical illness in the individual.
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Merrill, E Wilson' Coordinated Mental Health Care in Neighborhood Health Centers, Vol.
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