TREATING MENTAL-ILLNESS - GENERALIST VERSUS SPECIALIST

In an era of cost containment and escalating health spending, reduced access to specialty health services is evident across the health sectors. On the mental health front, alternatives to specialty mental health services are the focus of recent debate as policy analysts question the merits of generalist versus specialist care. Sociologist David Mechanic suggests that the public should not be misguided by recent research findings that general medicine can fill the gap for providing specialty mental health services. ''Much of the [mental health] care provided by general medical providers is superficial,'' he said, warning of the danger in relying on general practice physicians to provide specialty mental health services. In this article, Mechanic analyzes findings from major health services research studies, which may have contributed unintentionally to the wide perception that general practice physicians are ''a suitable alternative or substitute for more specialized services for the mentally ill.'' Mechanic declares that these beliefs may reinforce efforts to limit mental health specialty benefits. He examines policy measures that encourage strategies to link medical care and specialty mental health services more closely. Mechanic is the director of the Institute for Health, Health Care Policy, and Aging Research and Rene Dubos Professor of behavioral sciences at Rutgers University, where he formerly served as dean of the Faculty of Arts and Sciences. He holds a doctorate in sociology from Stanford University and is a member of the Commission on Behavioral and Social Sciences and Education of the National Research Council, Institute of Medicine. Mechanic is the author of numerous books and articles on health policy and health services research, many of which have appeared in Health Affairs.