Role of Nonpsychiatrist Physicians in the Delivery of Mental Health Services: Implications from Three Studies

In a series of three studies in Monroe County, N.Y., data were obtained on the extent to which nonpsychiatrist physicians in a variety of medical settings detected emotional problems in their patients. The disciplines and settings included internists and general physicians in private office practice...

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Bibliographic Details
Published in:Public health reports (1974) 1978-05, Vol.93 (3), p.240-245
Main Authors: Goldberg, Irving D., Haroutun M. Babigian, Locke, Ben Z., Rosen, Beatrice M.
Format: Article
Language:English
Subjects:
Affective Symptoms - diagnosis
Affective Symptoms - epidemiology
Delivery of Health Care
Disorders
Emotional problems
Family Practice
Health care delivery
Hospitals, General
Humans
Internal Medicine
Mental health
Mental Health Services
Mood disorders
New York
Occupational Medicine
Physicians
Physicians - utilization
Private Practice
Psychiatric diagnosis
Psychiatric hospitals
Public health
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Summary:In a series of three studies in Monroe County, N.Y., data were obtained on the extent to which nonpsychiatrist physicians in a variety of medical settings detected emotional problems in their patients. The disciplines and settings included internists and general physicians in private office practice, industrial dispensaries, and general medical clinics of general hospitals. A population-based psychiatric case register, which receives reports on patients of psychiatric facilities and psychiatrists in private office practice in the county, made it possible to match the subjects in the three studies to that register to determine if those considered to have, or not to have, an emotional problem by their general physicians were also known to the register. Findings indicated that patients judged by their general physicians to have emotional disorders are much more likely than other patients to receive care in a specialty psychiatric setting for the first time within a year following the medical visit. Nevertheless, only 14 to 38 percent of patients judged to have an emotional disorder received care from specialty psychiatric settings within periods up to 6½ years before and 3½ years after the medical visit. Further, for the three groups of study patients, the estimated "annual diagnosed prevalence" of mental health problems, including persons diagnosed in the nonpsychiatric medical settings, was at least 2½ to 10 times as great as that based solely on those who received care in psychiatric settings; the estimated "lifetime diagnosed prevalence" was 2½ to 6 times as great. Thus, a significant proportion of the persons seen by nonpsychiatrist physicians have identifiable emotional disorders requiring care, yet many of those so diagnosed are not seen in specialized psychiatric settings. Planning of community mental health services should take into account the training and role of the nonpsychiatrist physician in the detection, management, and referral of persons with mental health problems. This patient management function of nonpsychiatrist physicians takes on additional importance when considering delivery of mental health services under a future national health insurance program.
ISSN:0033-3549
1468-2877