Psychiatry and primary care in the USA


University of Southern California (USC), Keck School of Medicine, Department of Psychiatry and the Behavioral Sciences, Los Angeles, USA


During the last several decades, great progress in the diagnosis and treatment of mental disorders has been made. The discovery and use of effective psychotropic medications, advancement in neuroscience, establishment of community mental health system and mental health laws, and utilization of psychosocial rehabilitation have significantly impacted the treatment outcome of mental disorders. Despite the facts there are these effective treatments, there are still critical issues negatively impacting the prevention and treatment of mental disorders. Barriers for utilization of mental health services include perceptions and attitudes toward mental disorder (social stigma and discrimination), cultural differences in dealing with mental disorder, inaccurate assessment and diagnosis, lack of resources, fragmented mental health delivery system, lack of trained mental health professionals, and inadequate treatments. Due to the lack of access of mental health treatment including shortage of psychiatrists, primary care physicians frequently assume the role as the providers for people with mental health issues. Currently, the process of health care reform is swiftly moving forward globally, many countries are experiencing a variety of rapid changes in the mental health system of care. As we all know, “There is no health without mental health”, there is urgent need to “Integrated Primary and Mental Health Care: Reconnecting the Brain and the Body.” Integrative and collaborative care between psychiatrists and primary care physicians can improve patients’ both physical and mental health and at the same time lower overall health care costs. For example, recent studies have shown that concurrently treating behavioral and physical conditions, not only leads to better control of depression, diabetes, and heart disease, but also has been shown to reduce health care costs. Recent developments and recommendations on future directions pertaining to psychiatry and primary care will be presented.