Introduction

Findings from the Epidemiologic Catchment Area (ECA) studies, supported by the National Institute of Mental Health, demonstrate not only the prevalence of mental disorder, but also the tremendous gap between need and service. This chapter addresses the challenges of mental health service delivery in these multiple systems of care. The findings of Badger, Berbaum, Carney, Dietrich, Owen, and Stem suggest that physicians may be doing a better job detecting and responding to depression than in earlier years. Nonetheless, evidence of significant gender differences, with male physicians failing to discuss and recommend depression treatment as often among male patients, is troubling. Research examining provision of mental health services within general medical sectors has been a major program emphasis of the NIMH. Social work was designated as one of the four core mental health professions in the federal legislation establishing the NIMH, and social workers are the largest professional group of mental health service providers.