Improving Our Public Mental Health Systems

Dr Koran and his colleagues are to be congratulated for their article in this issue.¹ In a well-designed study, they have demonstrated that almost half the patients in a large state public mental health system had an important physical disease, and that almost half of these diseases had gone unrecognized by that mental health system. This included many diseases causing or exacerbating mental disorders. This study highlights a vitally important part of diagnostic screening that is too often neglected in public mental health systems. The study also provides an excellent example of the kinds of diagnostic screening that should be done with psychiatric patients. If careful medical evaluations were done on a routine basis, these extensive findings of undiagnosed illnesses would not be possible. In this era of inadequate funding and rationed health care in the public sector, including psychiatric care, it is unfortunate but typical that such a