Primary care
Primary care has often been termed the "de facto" mental health system in the United States. Research shows that approximately half of all mental health care services are provided solely by primary care providers. Furthermore, primary care practitioners prescribe about 70% of all psychotropic medications and 80% of antidepressants. Thus, while it seems there are various "specialty" mental health clinics and psychiatrists alike, the primary care environment continues to lend itself to an array of psychiatric issues. One reason is that physical health problems can contribute to psychological dysfunction and vice versa. Examples of the frequent comorbity between medical and psychological problems include: chronic pain can cause depression; panic symptoms can lead to complaints of heart palpitations; and stress can contribute to irritable bowl syndrome. While these mind-body relationships may seem obvious, often the presenting problem is far less clear, with the physical health problem being masked by psychosocial concerns. In fact, of the 10 most common complaints in primary care, less than 16% had a diagnosable physical etiology. The psychosocial impact on primary care is tremendous (approximately 70% of all visits); however, it is curious that few mental health providers have traditionally placed themselves where the demand for their services is arguably the greatest.