ABSTRACT
Health care providers who work in primary care settings provide numerous services to patients troubled by mental and behavioral impairments (Shapiro et al., 1984). Primary care physicians spend almost one quarter of their work week providing direct treatment for psychiatric conditions (Howard, 1992). In fact, more mental health services are delivered in the primary care setting than in any other health care setting in America (Knesper & Pagnucco, 1987; Magil & Garrret, 1988). During the past decade, primary care providers have begun to partner with mental health providers to improve outcomes in what has been called the de facto mental health system in America (Regier, Goldberg, & Taube, 1978). Group Health Cooperative of Puget Sound has a 13-year history of integrating behavioral health services into the primary care treatment setting. This pioneering health care system has developed models for general behavioral health consultation service (Strosahl, 1996,1997) and programmatic treatment of depression (Robinson, Wischman, & Del Vento, 1996).
