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May 9, 1986

Physicians and the Mental Illnesses: The Nudge From ADAMHA

Author Affiliations

UCLA School of Medicine Los Angeles

JAMA. 1986;255(18):2485-2486. doi:10.1001/jama.1986.03370180111045

The overview article1 from the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) published in the April 18, 1986, issue of JAMA vividly highlights the prevalence and costs of substance abuse and mental illnesses and our deficiencies in diagnosing and treating them. The broad scan of epidemiologically well-established facts, of the excess of mortality, and of medical resource utilization should be eye-opening. Yet the very generality of the prescription— improved education—and the unavoidable monotony of the catalog of defects may be mind-dulling. This would be unfortunate. The multiple assertions refer to real and not fictional issues.

For almost a decade, we have known that well over 50% of all cases of these illnesses are encountered in the primary care rather than specialty sector. Today, we should expect no less than a sound physical workup in psychiatric patients and an equally competent physical and psychodiagnostic workup in medical patients with