Psychiatry and general health care

The paper presents a study of psychiatric morbidity in the general health care program of a Health Maintenance Organization. Mental health services are built into the program as an integral component of primary care teams in internal medicine and pediatrics. The following were some of the findings: 15.7% of patients visiting the Health Center over a two-year period presented emotional problems; 72% were treated by primary care clinicians alone and 28% by mental health clinicians. Treatment by primary and mental health clinicians is broken down by diagnostic categories. A study of patients with chronic emotional problems revealed that they tended to be high utilizers of all Health Center services for both physical and emotional difficulties. Chronic patients represented 2% of all patients who visited in 1974; of these, 54% were seen by mental health clinicians and 46% by primary care clinicians. In the case of patients with non-chronic emotional problems, over a two-year period, there was an increase in the per cent seen by primary clinicians. The use of psychoactive drugs by primary physicians and the advantages and difficulties of developing a program of integrated health-mental services are described.