MENTAL-HEALTH-SERVICES IN ARMY PRIMARY-CARE - THE NEED FOR A COLLABORATIVE HEALTH-CARE AGENDA

Epidemiologic studies have shown that more than half of mentally ill p atients in the United States receive their psychiatric care exclusivel y in primary care settings. This fraction may be even higher in the mi litary due to concern over possible occupational repercussions resulti ng from use of specialty psychiatric care and specialist shortages. Co llaboration between generalists and mental health care specialists cou ld potentially improve mental health care delivery and reduce psychiat ric disability for a large segment of the Army population who have a p sychiatric disorder but may not seek specialty care. Collaborative eff orts can reinforce military generalists' essential gate-keeping functi on, thereby decreasing unnecessary medical utilization and health care costs. The authors review the problems associated with mental health care delivery in primary care and provide examples of collaborative mo dels previously studied or currently being explored. A four-part Army Primary Care-Mental Health Services Agenda is proposed, consisting of: (1) coordinated research including primary care-mental health service s research and community-based epidemiologic studies; (2) formation of a primary care-mental health services advisory committee for aiding w ith policy and program development; (3) graduate and continuing medica l education in primary care-mental health services emphasizing interdi sciplinary collaborative skills; and (4) clinical implementation of fe asible collaborative interdisciplinary mental health care models adapt ed to the range of unique Army primary care settings. The main goal of the Army Primary Care-Mental Health Services Agenda is to improve acc ess to Army mental health care in the most efficacious and cost-effect ive way and to help minimize the organizational impact of disability r elated to psychosocial distress.