Family Physicians Are an Important Source of Mental Health Care

One Pagers | Apr 01, 2003 Anu Subramanian PhD; Susan Dovey, MD, MPH; Larry Green, MD; Ed Fryer, PhD; Robert Phillips, MD, MSPH

While comprising about 15 percent of the physician workforce, family physicians provided approximately 20 percent of physician office-based mental health visits in the United States between 1980 and 1999. This proportion has remained stable over the past two decades despite a decline in many other types of office visits to family physicians. Family physicians remain an important source of mental health care for Americans.

According to the Institute of Medicine, mental health care is indivisible from primary medical care. Family physicians and general practitioners (FP/GPs) provide more office-based primary medical care than any other medical specialty. To characterize this care, data from the National Ambulatory Medical Care Survey (NAMCS) were analyzed for the contribution made by FP/GPs towards the mental health care of Americans over a 20-year period. The NAMCS was conducted twice from 1980 to 1984, twice from 1985 to 1989, and annually since 1990. NAMCS data allow analysis of physicians' mental health diagnoses coded as the first diagnosis for each office visit, undistorted by billing considerations.

Of all office-based physician visits from 1980 to 1999 with a mental health problem reported as the first diagnosis, approximately 20 percent were provided by FP/GPs. The remaining 80 percent were distributed among all other medical specialties. Of note, these data do not include mental health care provided by psychologists. This distribution has remained stable over a 20-year period that included mental health "carve-out" systems and managed care. In contrast, FP/GPs visits as a proportion of total physician visits for any diagnosis have decreased from 32.9 percent in 1980 to 1985 to 24.6 percent in 1995 to 1999.

Psychophysiologic diseases, schizophrenic disorders, acute stress reactions, and hyperkinetic syndromes are increasingly managed by family physicians, while care for depressive and neurotic disorders remains about the same (Table 1).

Table 1. Percent of Total Office Visits for Mental Health Diagnoses by FP/GPs vs. All Other Medical Specialties Combined: 1980-1999

Five-Year PeriodsPercentage of Mental Health Visits to FP/GPPercentage of Mental Health Visits to Other Specialites
Five-Year Periods: 1980-1984Percentage of Mental Health Visits to FP/GP: 20.8Percentage of Mental Health Visits to Other Specialites: 79.2
Five-Year Periods: 1985-1989Percentage of Mental Health Visits to FP/GP: 17.6Percentage of Mental Health Visits to Other Specialites: 82.4
Five-Year Periods: 1990-1994Percentage of Mental Health Visits to FP/GP: 19.2Percentage of Mental Health Visits to Other Specialites: 80.8
Five-Year Periods: 1995-1999Percentage of Mental Health Visits to FP/GP: 19.3Percentage of Mental Health Visits to Other Specialites: 80.7

Family physicians have been and remain an important source of mental health care for Americans (Table 2).

Table 2. Percentage of Total Office Visits for Specific Mental Health Diagnoses Provided by FP/GP’s: 1980 to1999

Mental Health Diagnoses1980-19841985-19891990-19941995-1999
Mental Health Diagnoses: Psychophysiologic Diseases (1)1980-1984: 21.0%1985-1989: 46.1%1990-1994: 26.5%1995-1999: 48.2%
Mental Health Diagnoses: Schizophrenic Disorders1980-1984: 4.1%1985-1989: 5.1%1990-1994: 7.4%1995-1999: 8.4%
Mental Health Diagnoses: Special Symptoms (2)1980-1984: 43.1%1985-1989: 47.4%1990-1994: 46.9%1995-1999: 39.2%
Mental Health Diagnoses: Acute Stress Reaction1980-1984: 29.5%1985-1989: 28.2%1990-1994: 24.1%1995-1999: 33.0%
Mental Health Diagnoses: Depressive Disorder1980-1984: 36.3%1985-1989: 34.0%1990-1994: 42.0%1995-1999: 37.9%
Mental Health Diagnoses: Neurotic Disorders (3)1980-1984: 22.8%1985-1989: 21.2%1990-1994: 20.4%1995-1999: 22.9%
Mental Health Diagnoses: Hyperkinetic Syndrome (4)1980-1984: 7.4%1985-1989: 11.8%1990-1994: 19.3%1995-1999: 19.7%
Mental Health Diagnoses: 1 musculoskeletal, skin, gastrointestinal, endocrine, genitourinary, cardiovascular or respiratory disorders arising from mental disorders
2 stammering, stuttering, tics, anorexia nervosa and other eating disorders
3 anxiety, hysteria, obsessive-compulsive disorders, hypochondriasis
4 attention deficit disorder of childhood, hyperkinetic conduct disorder of childhood

The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP. 

Published in American Family Physician, Apr 1, 2003. Am Fam Physician. 2003;67(7):1422. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.