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Over the last two decades, epidemiologic studies have shown that mental health disorders (largely depressive, anxiety, and substance abuse disorders) occur in approximately 20%–25% of primary care patients and that quality of mental health care is poor and mental health outcomes are problematic (Seelig and Katon 2008). This results in unnecessary suffering of patients and their families, as well as high costs to both employers and the health care system. Epidemiologic studies have also shown that patients with major depression (who are largely treated in primary care) as well as those with severe mental illness (who largely receive care in community mental health centers) have high rates of medical comorbidity and often have major deficits in being able to access primary care and specialty medical care, as well as problems affording disease-control medications for chronic medical illnesses (Bradford et al. 2008). Recent studies have shown that patients with depression as well as those with serious mental illness (SMI) are dying about 10–20 years earlier from chronic medical illnesses (Druss et al. 2011).
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