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There has been much discussion about the high prevalence of psychiatric problems among patients of primary care physicians. The questions of particular interest are: to what extent do emotional problems appear as presenting complaints, and are they problems with which a primary care clinician might be expected to deal? A number of studies have reported a fairly consistent level of presenting emotional difficulties: about 14 per cent in general practices in England,' Australia,2 and Austria.3 In one study, it was reported that "a large proportion of psychiatric morbidity encountered in general practice is made up of chronic disorders, and in a seven-year follow-up study more than half the cohort showed a very poor outcome in terms of recurrence or chronicity."4 It was also found that emotional disorders were "associated with high demand for medical care," and that they showed "higher rates of general morbidity and more categories of illness per head than the remainder of the patients consulting their doctors."5In this paper, we shall address the question of psychiatric morbidity in a general health care program on the basis of a five-year experience

The paper describes interactions between primary care physicians (PCP's) and mental health clinicians (MHC's) in a "team collaborative model." A study of the interactions showed there were about two consultations a day with PCP's for each MHC, that they were largely unscheduled, took place mostly in PCP or MHC offices or in corridors, and increased in frequency over a two-year period. Role definition was a continuing process; PCP's and MHC's each learned through repeated discussions what to expect from the other in patient care. It is found that a model with close working arrangements between PCP's and MHC's is of therapeutic value for that large population of emotionally disturbed patients seen often by PCP's much less often by MHC's.

Recently, there has been a considerable increase in the use of the general hospital emergency room for all kinds of health problems, and it appears that the emergency room is serving as the "poor mnan's doctor." A large number involves acute social crises and are psychiatric problems. The authors discuss the possibilities and limitations of such a facility for care of psychiatric patients and for teaching purposes.

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