ORIGINAL ARTICLE Barriers to the Treatment of Mental Illness in Primary Care Clinics in Israel Liat Ayalon • Khaled Karkabi • Igor Bleichman • Silvia Fleischmann • Margalit Goldfracht Published online: 5 February 2015 Ó Springer Science+Business Media New York 2015 Abstract The present study examined physicians’ per- ceived barriers to the management of mental illness in primary care settings in Israel. Seven focus groups that included a total of 52 primary care Israeli physicians were conducted. Open coding analysis was employed, consisting of constant comparisons within and across interviews. Three major themes emerged: (a) barriers to the manage- ment of mental illness at the individual-level, (b) barriers to the management of mental illness at the system-level, and (c) the emotional ramifications that these barriers have on physicians. The findings highlight the parallelism between the experiences of primary care physicians and their pa- tients. The findings also stress the need to attend to physicians’ emotional reactions when working with patients who suffer from mental illness and to better structure mental health treatment in primary care. Keywords Depression Á Anxiety Á Primary care Á Anti- depressants Á Anti-anxiety Á Physicians Á Integrated care Á Psychotropic Á Psychotherapy Introduction Depression and anxiety carry a major toll on individuals, families and society at large. This has led the World Health Organization to identify depression as the second leading cause of disability worldwide (Murray and Lopez 1996). Currently, about 10 % of primary care patients suffer from depression and as many as 7 % suffer from at least one type of anxiety disorder (Serrano-Blanco et al. 2010). Primary care providers serve as major gatekeepers in the treatment of depression and anxiety (Thombs et al. 2012). Despite the prominent role of primary care providers in the management of depression and anxiety and the various interventions employed to facilitate the treatment of mental illness in primary care (Katon et al. 2010; Vickers et al. 2013), there is a growing body of literature on barriers to adequate mental health care in primary care (Whitebird et al. 2013). The literature addresses three major types of barriers for the management of mental illness in primary care. These include barriers at the contextual level, the patient level and the provider level (Benzer et al. 2012; Schumann et al. 2012). At the contextual level, reimbursement strategies, lack of resources and time, the stigma of mental illness (Schu- mann et al. 2012), inadequate care coordination and diffi- culties initiating referrals to mental health providers have shown to impact access to mental health treatment in ‘‘SSRI is for us not for the patients:’’ Barriers to the Treatment of Mental Illness in Primary Care Clinics. L. Ayalon (&) School of Social Work, Bar Ilan University, 52900 Ramat Gan, Israel e-mail: liat.ayalon@biu.ac.il K. Karkabi Clalit Health Services, Tel Aviv, Israel K. Karkabi Á M. Goldfracht Technion-Israel Institute of Technology, Haifa, Israel I. Bleichman Medical Social Work Department, Clalit Health Services, Tel Aviv, Israel S. Fleischmann Nursing Department, Clalit Health Services, Tel Aviv, Israel M. Goldfracht Community Division, Headquarters Clalit Health Services, Tel Aviv, Israel 123 Adm Policy Ment Health (2016) 43:231–240 DOI 10.1007/s10488-015-0634-0