THE EVOLUTION of health policy and clinical science has had a substantial influence in recent decades on the relationship between mental health and general health. Federal initiatives encouraging linkages between community mental health centers and community health centers, the growth of Health Maintenance Organizations and other organized care settings, health manpower legislation with a mandate for primary care, and advances in biologic psychiatry and behavioral medicine all have contributed to the movement of mental health into the mainstream of health services.
Evidence of the developing relationship is seen in analyses of the de facto mental health and health service systems. Recent data by Regier et al1 indicate that of the estimated 35 million persons in the United States who suffer a diagnosable mental disorder annually, approximately 54% are seen exclusively in the general health care sector. Moreover, between 15% and 50% of all patients visiting primary care physicians have