icient for improving the treatment of depression in primary care and that there are promising signs that the model is applicable to other mental health conditions. "Collaborative care has been shown to be predictably efficacious and effective if the type of relationship between mental health and medical providers, the population served and the type of service provided are adequately specified7 ."
The current health care system is unable to adequately address both sides of the primary care/behavioral health interface. Although primary care provides the majority of mental health care, barriers such as lack of financial compensation and available time with consumers make it difficult for health care systems to implement effective treatment strategies. Unfortunately, primary care providers commonly fail to recognize or treat some disorders including substance use disorders or depression. Physicians may lack the knowledge or the time to adequately diagnose and treat mental health conditions. Mental health providers suffer some of the same problems with a lack of knowledge of or time to diagnose physical health conditions.
The primary responsibility for providing mental health care continues to fall on primary care. In fact, 54% of individuals with a mental health condition are served in primary care settings. According to the American Academy of Family Physicians, 42% of patients with clinical depression and 47% with generalized anxiety disorder (GA) were first diagnosed by a primary care physician 8 . It is also important to note that most individuals prefer to receive their mental health care within primary care since it is perceived as less stigmatizing than the traditional mental health system 9 . The role of primary care identification and treatment of mental health conditions is important for special populations including older adults and low-income minority populations that are likely to go undiagnosed due to a lack of access to primary care. In addressing how to integrate mental health and general health, the Surgeon General's 2000 Report: Integration of Mental Health Services and Primary Health Care provides a set of twelve core principles to facilitate the development and implementation of national and local programs. They include an emphasis on consumers and their families, promotion of health and overcoming disparities, basic characteristics, financial incentives for team approaches, reimbursement to support evidence-based care, collaboration/collocation, chronic illness and continuity of care, standardized quality and outcome measures, building on existing models, research and demonstrations, investment in training, and information technology 10 .
Call to Action
Mental Health America is dedicated to supporting national, state, and local efforts to integrate mental and general health care and to continued efforts to improve the quality of mental health and substance use services available in general health care settings and the quality of primary health care services available in specialty mental health care settings. Our goal is to foster the broad implementation of available research and models in real-world health delivery systems, to ensure that services are appropriate to the population being served, and to eliminate the clinical, financial, policy and organizational barriers to the integration of mental and general health care.
- The integration of mental and general health care must occur at all system levels including the federal, state, and local levels. It also requires a clear effort to overcome the clinical, financial, policy and organizational barriers to fully integrating mental and general health care.
- Many effective mental health services, especially psycho-social, recovery-oriented and rehabilitation services have not been provided in traditional medical treatment settings. It is essential that such services be provided as components of integrated treatment of mental health conditions.
- The federal government should clarify the ability of primary care providers to bill for mental health service