Raul H. Vispo, M.D.
Integration of Behavioral Health Services with Primary Care Ser-
vices is not a new ‘‘fad’’ in the health care world. In some sense it
can be seen as the logical evolution of the old psychosomatic con-
cept and the liaison services of the ‘forties to the seventies’. The
changes in the health delivery system with the increasing concern
in appropriateness of care, quality and cost make the need of an
early and continuous interaction logical between the two services.
The many cases where a panic attack is misdiagnosed as
heart attack or a depression is not considered as a possible diag-
nosis when confronted by a case of loss of appetite, lack of energy
and general malaise are examples where a close interaction be-
tween the two ﬁelds would deﬁnitively have a positive effect on
the type and quality of treatment. But as with many other things
that are logical and worthwhile in theory, they can be difﬁcult to
translate into practice.
The group of papers brought together in this issue of Psychi-
atric Quarterly describe programs that try to overcome the difﬁ-
culties of integration between these two disciplines.
These programs have a common denominator that very much
color the delivery of services. All the centers in which these ser-
vices are provided are related to the national ‘family’ of Kaiser-
Permanente, a not for proﬁt Health Maintenance Organization
(HMO) in which a staff or group practice is the core component of
the delivery system. Obviously the philosophy and structure of
the organization facilitates these kinds of integrated programs.
The opening article by Robin A. Dea and the closing one by
Michael P. Quirk’s group, in many ways complement each other.
They will give the reader unfamiliar with the complexities of the
system some insight into the hard work and commitment neces-
PSYCHIATRIC QUARTERLY, Vol. 71, No. 1, Spring 2000
0033-2720/00/0300-0015$18.00/0 2000 Human Sciences Press, Inc.