It promised to be a very important resource to the primary care setting, but at present, the performance has not been considerable and there have been lack of funds and local consensus, which thwart its implementation (Pidd). Shared Care Between GP Practices and Community Health Teams

This initiative aimed at developing cooperative partnership between these teams as well as establishing systems for proactive, structured care at the practice level (Pidd 2004). Implementation has similarly been problematic. When effected, it would insure the engagement and involvement of the key staff in GP practice and local community mental health teams; a participative, facilitated process for the shared care conceptual framework; joint working groups to develop shared care agreements; and a shared understanding of priorities for improvement. Meanwhile, pilot studies conducted on personal medical services identified five factors, which could enhance successful quality improvement. These were effective collaboration with community and secondary care, effective team work within the practice, routine protocols and audits, clear objectives, and supplemental or additional financial resources. Previous and strong evidence of good organization and team work at the practice level indicated or influenced success. There have been indications of progress but, for the most part, these have been mere indicators. Nonetheless, the investment has been intensive (Pidd).

Obstacles and Issues

Little Attention Paid to Improving Primary Mental Health Care

Studies established that, in many countries, psychiatric patients had high rates of physical illness, much of which was said to be undetected (Phelan 2001). The occurrence was brought to the awareness of health professionals but there has been no evidence of response to curtail it. Instead, not only do excess illness and mortality continue to rise but also that the psychiatric outpatients now are twice as likely to die as the general population. In most industrialized countries, the trend has been to close long-stay mental hospitals and put up community mental health teams, which are designed to provide the whole range of health and social needs. Hospital admissions have lately become short and infrequent. However, many mental health practitioners have little training in physical care and the physical assessment of psychiatric patients by junior psychiatrists has been found to be below par and their monitoring generally unsatisfactory. Most patients with severe mental illness get in frequent contact with primary care services, yet this contact does not give them or insure that they receive proper physical care. Primary care has been reactive and not responsive to patients who are reluctant or unable to seek help. Doctors are also unable to assess a patient's mental state or condition during short consultations or if the patient is vague about his or condition or is suspicious about the doctor. The doctor may also be inexperienced or uncomfortable with mental health work and may resist probing deeper into the patient's symptoms while performing a physical examination. Current opinion is to establish group therapy, which can help patients with schizophrenia, for example, to stop smoking. But this initiative should be backed by strong research and address negative staff attitudes. Progress would depend on the awareness of the problem by both the mental health and primary care staff and their combined efforts at searching for and implementing imaginative and responsive solutions, which their patients would accept and consider useful (Phelan).

Fragmented Linkages of Substance Abuse Treatment with Community-Based Services

This fragmentation developed in the 80s when persons disabled with serious physical and mental disorders were considered a heavy social problem (Lee 2006). The issue grew stronger when more and more persons afflicted with substance abuse, mental illness and chronic health problems such as HIV / AIDS, began receiving outpatient treatment. This approach has been frustrating to outpatient abuse treatment providers because their clients often discontinue early, go on relapse and fall back into the habit. Researchers suggested that multiple types of treatment be provided these clients through better service linkages between outpatient substance abuse treatment entities and other service providers in order to reduce recidivism. Findings of studies and empirical evidence showed that clients receiving methadone had lower incidence of relapse when they also received ancillary services, particularly mental health services. An evaluation of a combined substance abuse and mental health case management program revealed a 31% reduction among those dually diagnosed as compared with 6% of a typical service control group. Other studies showed that those receiving services functioned better in the community than those who did not. It might take some time to link outpatient substance abuse treatment or OSAT with other...

But OSATs have been reported to making adjustments with their patterns of service linkages to the needs of substance abuse clients. Other barriers to effective linkage included inadequate insurance coverage, organizational capacity, which can be made worse by diminishing government funding during the present economic downturn (Lee).
Obstacles to Accessing Primary Mental Health Care

Managed care under the American health care system does not cover mental disease (Menaged 2003). Insurance companies look to mental health benefits as the first place to cut in an attempt to reduce rising costs. Mental health costs have been the most difficult to predict and assess and, therefore, the most risky. Every course of treatment differs from patient to patient. Other insurers sign risk agreements with providers and hospitals to administer the mental health care by their insurance subscribers in exchange for a fee. Because these administrators fix the meaning of necessity and make money out of it, private companies resort to determining what necessity was for treatment, often according to the view of the attending psychiatrist or therapist or as set by the American Psychiatric Association. Either way, insurance companies would deny the benefit. Even when mental health benefits existed, the criteria and requirements imposed by insurance companies or benefit administrators were so stringent as to render the benefits virtually inaccessible or unattainable. It has been even more difficult in inpatient cases wherein man insurance companies grant benefits only out of medical necessity, often translating to a suicide attempt. If and when the criterion for medical necessity is met, the mental disease is not necessarily cured. Hence, recurrence results in repeat episodes and succeeding hospitalizations. Victims and other clients of mental illness must eliminate obstacles before they can access needed care. These are the their own determination or choice of treatment, the right to pay privately, the exclusion of specific diseases and lack of strong link between medical or surgical care and mental health care. Treatment is required for sickness or disorder, whether visible under a microscope or invisible to eye. But the current system does not provide for the invisible and this is the current burden of mental sufferers (Menaged).

Social Disparities

Findings of a series of studies established the significant connection between the supply of primary health care and population health (Shi 2002). Those who consulted primary-care physicians, had greater accessibility and enjoyed interpersonal relationship with these physicians were reported to be generally and mentally healthy than those who did not have the same experience. Furthermore, good primary care experience also reduced the adverse impact of income inequality on health. Nonetheless, income inequality exerted strong and adverse impact on mental health, which experts and critics saw could be managed by addressing the psychosocial effects of relative deprivation on levels of frustration, which had adverse health consequences. In addition to primary-care experience and income inequality, socio-economic characteristics, such as income and education, were distinctively associated with general health and depression (Shi).

III. Developments

Effects of Cutting Back on Health Coverage

In the last several years, the number of companies offering mental health benefits decreased from 84 to 76%, according to the annual benefits surveys conducted by the Society for Human Resource Management (Tyler 2003). Companies did so to reduce steeply rising health care costs, but doing so may result in higher health cost in the long run. Untreated mental illness could lead to physical ailments and result in reduced productivity or extended disability leave. Every year, around 22% of adults working in the U.S. suffer from some diagnosable mental health disorder, according to the report of the National Institute of Mental Health in Bethesda, Maryland. The most common mental health disorders in the workplace have been anxiety and depression - including major, chronic, and bipolar or manic depression. Health insurance premiums are expected to go up to as much as 15%, inclining employers to reduce or eliminate these benefits. Untreated behavioral illnesses can lead to loss of productivity while depression can compromise employee safety (Tyler).

Legislation

Mandating mental health benefits has already been an ongoing policy process, as in fact, more than as many states have enacted legislation and the mandates have become more typically comprehensive than previous ones (Bao 2004). However, state legislation has not proved to be adequate substitutes of a federal legislation. State legislation did not appear to have…