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Mental illnesses rank first among illnesses that cause disability (President's New Freedom Commission on Mental Health, 2003). Yet, mental health services are fragmented, disconnected, and inadequate (Hogan, 2003). In addition, faulty reimbursement systems and stigma toward mental illness compound system inadequacies.
The dire state of untreated mental health problems worldwide led the President's New Freedom Commission on Mental Health (2003) and the World Health Organization (WHO) (2001) to call for action to improve the mental health system of care and to create continuously accessible, quality mental health care. As critical partners in the health care delivery system, nurse educators need to prepare graduates to provide leadership and respond effectively to this national and global health care need (American Academy of Nursing, 2006).
One proposed strategy for improving the system of mental health care is to strengthen available mental health expertise in the primary care site, the most common entry point into the mental health system (WHO, 2003). One in four Americans experience mental illness, but only two thirds of these individuals seek mental health care.
Most individuals who seek mental health care will request care from their primary care provider, with whom they are familiar. Primary care clinical visits are more likely to be reimbursed by insurance carriers, and individuals can avoid the stigma associated with receiving care at a segregated mental health site. Unfortunately, primary care nurse practitioners (NPs) and other primary care health providers often have inadequate academic preparation to intervene effectively with patients' complex mental health needs (Blount, 1998; Lumby, 2007; Marion et al., 2004; Schulberg et al., 1997).
In an attempt to deliver the holistic care to which they subscribe, NPs and other primary care providers often refer patents to a distant mental health site. Unfortunately, referrals often create access barriers such as delayed time for the referral visit, transportation problems, and additional time expenditure for patients. Delayed and missed appointments often result, as well as inadequate communication between the primary care providers and mental health specialists. Fragmentation of care and isolation of physical health from mental health occurs.
Conversely, mental health specialists such as psychiatric NPs are ill prepared to meet the physical health needs...