Collaboration, consultation and referral in an integrated health-mental health program at an HMO.

The paper describes interactions between primary care physicians (PCP's) and mental health clinicians (MHC's) in a "team collaborative model." A study of the interactions showed there were about two consultations a day with PCP's for each MHC, that they were largely unscheduled, took place mostly in PCP or MHC offices or in corridors, and increased in frequency over a two-year period. Role definition was a continuing process; PCP's and MHC's each learned through repeated discussions what to expect from the other in patient care. It is found that a model with close working arrangements between PCP's and MHC's is of therapeutic value for that large population of emotionally disturbed patients seen often by PCP's much less often by MHC's.

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.

Primary care treatment of emotional problems in an HMO.

Integrating mental health services into primary care should improve the availability, access, and delivery of psychiatric care to the whole population. Health maintenance organizations (HMOs) are settings for the development of integrated medical-mental health services. This paper reports findings of a project to evaluate a team collaborative model in an HMO. In this model, primary care clinicians carry major responsibility for emotional problems of their patients, and mental health clinicians collaborate with and support primary care clinicians as well as treat referred patients. Over a two-year study period, 15.7 per cent of all patients who visited the HMO presented a mental or emotional difficulty. When psychotropic drug prescriptions were used as an unobtrusive measure for estimating underenumeration, this prevalence figure rose to 19 per cent. Primary care clinicians treated an increasing proportion of the emotional problem demand, although this increase could not be attributed only to the establishment of the team collaborative model. Findings concerning the psychiatric problems treated and psychotropic drugs prescribed by primary care clinicians are also presented. We conclude that the primary care clinicians did assume major responsibility for emotional problem treatment when encouraged and supported through the team collaborative process and other organizational arrangements.

The mental health of children in an HMO program.

Collaboration between pediatricians and mental health clinicians in an HMO has provided a useful method of identifying and caring for the usual spectrum of developmental and situational disturbances in children and the associated parent-child conflicts. A social worker is included in the primary-care team in pediatrics; other mental health resources are available when indicated. In 1974, 5.7% of total visits and 8.9% of all children under 19 years of age were noted to have emotional problems. A follow-up study carried out early in 1976 disclosed that most of the observed emotional problems were resolved or quiescent.

Integrating mental health services into primary medical care.

Primary care clinicians occupy a strategic position in relation to the emotional problems of their patients. Integrating mental health and primary medical services promotes available, coordinated, accessible, and less stigmatizing treatment by recognizing an indivisibility of the total person in illness and in health. Federal efforts to encourage Health Maintenance Organization (HMO) development as part of a national health program prompts serious attention to organizational arrangements for developing such an integrated program for medical-mental health care. We have found a team collaborative model in which mental health providers are members of a primary care team to be useful and promising. Supportive services are provided on a continuing basis through patterned relationships. Shared responsibility for patient care between physicians, nurse practitioners, physician assistants, and mental health workers provides built-in peer review and encourages intrateam consultation.

Social work in a pediatric primary health care team in a group practice program.

The inclusion of a psychiatric social worker as a member of a pediatric team in a prepaid group practice extends the range of pediatric mental health services to children. This paper discusses the collaboration of the social worker with the pediatricians and allied health personnel on the team in dealing with the emotional problems of referred children and their parents. Case examples are included. All cases seen by the social worker during a 6-month period are reviewed. With available psychiatric backup a wide range of emotional problems are identified, and effective mental health care is provided.

Procedure for isolating mutants defective in metabolite transport or utilization.

Mutants defective in uptake or utilization of a given metabolite can readily be obtained from facultative auxotrophs (for that metabolite) by penicillin enrichment under nonpermissive conditions in the presence of a low level of the required metabolite.