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TABLE OF CONTENTS Summary of An Invitational Conference on the Provision of Mental Health Services in Primary Care Settings I. Introduction 1 II. Background and Overview - 3 III. Keynote Presentations David A. Hamburg - 15 President, Institute of Medicine National Academy of Sciences Herbert Pardes - 21 Director, National Institute of Mental Health Merle Cunningham - 29 Bureau of Community Health Services Health Services Administration Gerald L. Klerman - 31 Administrator, Alcohol, Drug Abuse and Mental Health Administration IV. Summaries of Major Presentations Nature and Scope of Mental Health Problems in Primary Care Darrel Regier Division of Biometry and Epidemiology National Institute of Mental Health Panel: Delivering Mental Health Services in Primary Care Settings: Some Successful Models Chairman: Jonathan Borus Massachusetts General Hospital Neighborhood Health Center Model Barbara J. Burns - 51 Primary Care Research Section Applied Biometrics Research Branch, NIMH Mental Health in a Fee-for-Service Pediatric Practice Lawrence Pakula Timonium, Maryland - 41 - 59

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Treatment of Emotional Problems by Primary Physicians in an HMO Jules Coleman Community Health Center Plan New Haven, Connecticut 65 Questions and Comments on Treatment of Emotional Problems by Primary Physicians in an HMO - 71 Jerry M. Wiener Department of Psychiatry and Behavioral Sciences The George Washington University Medical Center Washington, D.C. Panel: Identification and Management of Mental Health Problems in Primary Care Settings Chairman: David A. Hamburg Training of Family Physicians in Mental Health Skills: Implications of Recent Research* David Goldberg University of Manchester England - 73 Observations on the Impact of Psychiatric Disorder upon Primary Medical Care ~ 75 Edwin Hoeper Marshfield Clinic Marshfield, Wisconsin Literature Review on Management of Emotionally Disturbed Patients in Primary Care Settings* - Janet Hankin Johns Hopkins Health Services Research and Development Center Baltimore, Maryland 85 Suicide Prevention by Family Physicians: Opportunities and Limitations - 87 Thomas Madden Department of Preventive Medicine Rush-Presbyterian -- St. Lukes Medical Center Chicago, Illinois Panel: Issues in Training, Organizational Structure and Financing Chairman: Steven Sharfstein Division of Mental Health Service Programs National Institute of Mental Health *Commissioned Paper

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The Primary Care Physician: Robert Lawrence Harvard Medical School Mental Health Skills* The Role of the Psychiatrist in Primary Care Settings: Issues and Problems Alan Jacobson Joslin Clinic Boston, Massachusetts Reimbursement of Mental Health Services in Primary Care Settings* Alexander Richman, in collaboration with Murray G. Brown and Vernon Hicks Dalhousie University Halifax, Nova Scotia - 93 - 99 95 Problems in Analyzing the Cost-Offset in Providing Mental Health Services in Primary Care Settings - 101 Herbert Schlesinger in collaboration with Emily Mumford and Gene V. Glass University of Colorado Medical School Denver, Colorado Mental Health as an Integrant of Primary Care* Michael Shepherd Professor of Epidemiological Psychiatry Institute of Psychiatry University of London V. An Integrated Summary of Invitational Workshop Discussions Group A Chair: A. Alan Fischer Rapporteur: Fredric Solomon Group B Chair: Lisbeth Schorr Rapporteur: William Lybrand Group C Chair: Barbara Starfield Rapporteur: Elena Nightingale VI. Summaries of the panel presentations: Future Directions in Coordination of Mental Health Services and Primary Care Julius Richmond - 139 Assistant Secretary for Health Department of Health, Education and Welfare *Commissioned Paper 119 - 121

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Gerald Klerman - 141 Administrator, Alcohol, Drug Abuse and Mental Health Administration George Lythcott - 143 Administrator Health Services Administration, DREW VII. Commissioned Papers VIII. Appendixes - 145 A. Conference Agenda - 247 B. Invitational Workshop Participants - 253 C. Postcripts - 259 D. Conference Staff - 289