Models of Mental Health Training for Primary Care Physicians JAMES J. STRAIN, MD, HAROLD A. PINCUS, MD, JEFFREY L. HOUPT, MD, LESLIE H. GISE, MD, AND ZEBULON TAINTOR, MD Of the 15% of the population with DSM III diagnosable disorders, 54% are seen exclusively by their primary care physician or by other health professionals. To understand how primary care physicians are prepared for this task the authors attempted to develop a taxonomy of mental health training programs for primary care physicians by: review of the literature, interviews with program sponsors, review of NIMH training grants, and site visits to teaching programs. From this process six program types were defined: consultation, liaison, bridge, hybrid, auton- omous, and postgraduate specialization. The characteristics and emphasis of these model types are described as well as program needs for future training. Competence in psychosomatic medicine, psychophysioiogic reactions, and the interactions of biologic, psychologic, and social factors in health and disease can be imparted to primary care physicians by such mental health training program designs. Available data indicate that the majority of persons with mental health problems are seen by general health providers, not by mental health specialists. The Presi- dent's Mental Health Commission esti- mated that 15% of Americans suffer from some form of mental disorder (1). Regier et al. (2) report that only 21% of these peo- ple go to psychiatrists and to other mental health specialists, whereas 54% are seen exclusively by their primary care physi- cian or by other health professionals. From the Consultation/Liaison Service, Mount Sinai School of Medicine, New York, New York, the De- partment of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, the National Institute of Mental Health, Rockville, Maryland, and the De- partment of Psychiatry, New York University, New York, New York. Address requests for reprints to: James J. Strain, MD, Department of Psychiatry, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10029. Funded by NIMH contract #278- 81-0022 OP. Received for publication June 22, 1983; revision received February 4, 1984. It has been noted also that between 15 and 50% of all patients with physical com- plaints who visit primary care physicians have some emotional or cognitive disorder (3). Studies suggest that many of these dis- turbances remain unrecognized by general health practitioners. Even when such dis- orders are identified, there are serious questions as to the general health provid- ers' knowledge of, use of, and proficiency in various physical, psychopharmaco- logic, and psychotherapeutic interven- tions (5-7). The relationship between general health and mental health attains even more im- portance when one considers the wealth of evidence accumulated in recent years showing the tremendous effect of behav- ioral factors on the development, onset, course, and treatment of physical disor- ders (8, 9). One such issue, therapeutic compliance, is a serious problem that per- vades the entire health care area. Recent estimates suggest that as many as one half to two thirds of patients simply disregard Psychosomatic Medicine Vol. 47, No. 2 (March/April 1985) Copyright © 1985 by the American Psychosomatic Society, Inc. Published by Elsevier Science Publishing Co., Inc 52 Vanderbilt Ave., New York, NY 10017 95 0O33-3174/65/$3.30