The Family Practitioner and Psychiatric Problems in the Old

To the Editor.—  In the Jan 23/30, 1987, issue of JAMA, the ORIGINAL CONTRIBUTION by German et al¹ and an editorial by Dr Glass² clearly make the points that psychiatric problems among seniors are common, that the incidence of such disorders is rising, that seniors underuse the formal mental health system as a result of fears of stigmatization, and that most mental health care provided to seniors is provided by primary care physicians. Furthermore, primary care providers frequently fail to diagnose these problems, and, when they do diagnose them, management may not be optimal. Shortened contact time with seniors and ageism are cited.Two important factors contributing to poor performance by nonpsychiatrists in this area, barely mentioned by Dr Glass, require expansion.Here in South Dakota, there is a problem with availability of formal mental health services that primary care providers may consult or refer patients to. Psychiatrists