Primary care is the de facto mental health system

This chapter is a review of the research literature that suggests that primary care is the de facto behavioral health services and care system. It will summarize and reiterate the following points that have been made in the research literature for many years: Most patients with psychological problems are seen in nonpsychiatric medical settings Many medical presentations contain significant psychological comorbidity. Strosahl and Robinson point out in Chap. 8 that presentations that are for specific psychological or substance abuse issues are infrequent. More often, psychological issues are found to be part of acute medical issues, such as sleeping problems, headache or gastrointestinal problems, as well as complex chronic medical conditions such as diabetes, cardiac conditions or pain. The costs of untreated or inadequately treated behavioral problems include lack of medical improvement, decreased compliance with medical treatment and overserviced and underserved patients. There are multiple clinical, administrative and financial barriers to effective psychological care in medicine and medical settings. The most effective response to these issues is developing medical-psychological collaborative care models in primary care practices. There is ample reason to think that this will produce the holy grail of medicine-better care and higher levels of patient-centered involvement, resulting in better health status and reduced need and demand for medical resources.