To the Editor:

We were pleased to read the September 1997 article “Mental Health Care: From Carve-Out to Collaboration.” It has been amazing to watch mental health services become less available to patients as an expensive labyrinth of administrative forces has been created to access mental health carve-outs and discourage competent, coordinated care of the patient.

We have a psychologist located in an office between exam rooms in our clinic. The psychologist is able to consult several times a day on mental health issues with residents and faculty. Often, he can be introduced to patients in need of mental health services during a regular clinic visit. The access and coordination of care is obviously clinically better than what carve-outs provide. Ultimately, we believe competent, coordinated care is less expensive than no care or poorly coordinated care.