Ethics and the Practice of Primary Care Psychiatry

Abstract

In the United States, as in many Western countries, the primary care clinic has become a very common site for diagnosis and treatment of psychiatric conditions. There has been a significant increase in mental health care visits in the primary care sector. In the 1980s, slightly over 40 % of patients receiving mental health care were diagnosed and treated by primary care physicians. Of this patient population, 75% were managed solely by primary care physicians without psychiatric or psychological consultation (Kessler, Demler, Frank, et al., 2005; Wang, Demler, Olfson, et al., 2006). Between the 1980s and 2010, the use of primary medical care for mental health services has increased by over 150%. By 2008, the primary care sector had become the the most common treatment setting for mental health problems in the United States (Cwikel, et al., 2008). For example, 50% of all patients in the U.S. treated for major depressive disorder are managed solely in the primary care sector. These physicians spend a total of 12.1 hours per week--nearly a quarter of their direct patient contact hours--providing mental health services. In the U.S., approximately 20% of psychotherapy sessions are provided by primary care physicians (Himelhoch & Ehrenreich, 2007). In the United Kingdom, mental health counseling is also a major activity among general practitioners. This surge occurred in the context of corresponding increases in the percentage of the general population receiving mental health care—from 12% per year in 1990-92 to 20% by 2000-2001 (Kessler, Demler, Frank, Olfson, et al., 2005).