Mental Health Care – Robert C. Smith, M.D.

My team developed the Mental Health Treatment Care Model (MHCM) to guide primary care providers in conducting basic mental health in primary care settings. Because upwards of 90% of primary care mental health problems present with physical symptoms, we have focused on this population in developing the MHCM, at the same time incorporating the standard psychological symptoms of mental disorders. The MHCM integrates material from the Interviewing and Personal Awareness tabs.

Textbook: SMITH RC, D’MELLO D, OSBORN G, FREILICH L, DWAMENA FC, LAIRD-FICK H: Essentials of Psychiatry in Primary Care: Behavioral Health in the Medical Setting, McGraw-Hill; 2019

I. Overview of Mental Health Problem and Need for Teaching

SMITH RC: (Question of the Year Competition) Educating Trainees About Common Mental Health Problems in Primary Care: A (Not So) Modest Proposal. Acad.Med.; 2011; 86:e16; online October 26. (PDF)

II. Diagnosis and Classification of Medically Unexplained Symptoms

SMITH RC, DWAMENA FC: Classification and Diagnosis of Patients with Medically Unexplained Symptoms, J. Gen. Intern. Med., 2007, 22:685-691. (PDF)

III. The Mental Health Care Model

SMITH RC: A Clinical Approach to the Somatizing Patient. J Fam Pract 1985; 21:294-301. (PDF)
SMITH RC, LEIN C, COLLINS C, LYLES JS, GIVEN B, DWAMENA FC, COFFEY J, HODGES A, GARDINER JC, GODDEERIS J, GIVEN CW: Treating Patients with Medically Unexplained Symptoms in Primary Care. JGen Intern Med, 2003;18:478-489. (PDF)

IV. Controlled Trials Demonstrating the MHCM is Evidence-Based

LYLES JS, HODGES A, COLLINS C, LEIN C, GIVEN CW, BIVEN B, D’MELLO D, OSBORN GT, GODDEERIS J, GARDINER JC, SMITH RC: Using nurse practitioners to implement an intervention in primary care for high-utilizing patients with medically unexplained symptoms. Genl Hosp Psychiatry, 2003; 25:63-73. (PDF)
SMITH RC, LYLES JS, GARDINER JC, SIRBU C, HODGES A, COLLINS C, DWAMENA FC, LEIN C, GIVEN CW, GIVEN B, GODDEERIS J: Primary Care Clinicians Treat Patients with Medically Unexplained Symptoms – A Randomized Controlled Trial. J Gen Intern Med. 2006; 21:671-677. (PDF)
SMITH RC, GARDINER JC, LUO Z, SSCHOOLEY S, LAMERATO L, ROST K: Primary Care Physicians Treat Somatization. J Gen Intern Med, 2009; 24:829-832. (PDF)

V. Teaching the MHCM

SMITH RC, LAIRD-FICK H, D’MELLO D, DWAMENA FC, ROMAIN A, OLSON J, KENT K, BLACKMAN K, SOLOMON D, SPOOLSTRA M, FORTIN VI A, FREY J, FERENCHICK G, FRANKEL R: Addressing mental health issues in primary care: An initial curriculum for medical residents, Patient Education and Counseling. 2014; 94:33-42 (PDF)
FREILICH L, LYLES J, SHARMA M, KAVUTURU S, LAIRD-FICK H, GRAYSON-SNEED K, SMITH RC: A Curriculum for Training Medical Faculty to Teach Mental Health Care—And Their Responses to the Learning. Journal of Clinical Outcomes Management. 2020, 27: 166-173. (PDF)

VI. Research in Patients with Mental Health Problems

A Train-the-Trainer Method in the MHCM is Effective and Provides a Dissemination Model

SMITH RC, LAIRD-FICK H, DWAMENA FC, FREILICH L, MAVIS B, GRAYSON-SNEED K, D’MELLO D, SPOOLSTRA M, SOLOMON D: Teaching Residents Mental Health Care, Patient Education and Counselling, 2018; 101:2145-2155. (PDF) https://doi.org/10.1016/j.pec.2018.07.023

Coding Method for the Mental Health Care Model

GRAYSON-SNEED K, SMITH RC, et al.: A Research Coding Method for Behavioral Healthcare Treatment,Patient Education and Counselling, 2018; 101:743-749 (PDF)

A Qualitative Profile of Medically Unexplained Symptom Patients

DWAMENA FC, LYLES JS, FRANKEL RM, SMITH RC: In their own words: qualitative study of high-utilizing primary care patients with medically unexplained symptoms; BMC Family Practice, 2009; 10:67. (PDF)

Diagnosis of Medically Unexplained Symptoms

SMITH RC, GREENBAUM DS, VANCOUVER JB, HENRY RC, REINHART MA, GREENBAUM RB, DEAN HA, MAYLE JE: Psychological Factors Are Associated with Health Care Seeking Rather than Diagnosis in Irritable Bowel Syndrome. Gastroenterology 1990; 98:293-301 (PDF )
SMITH RC, GREENBAUM DS, VANCOUVER JB, HENRY RC, REINHART MA, GREENBAUM RB, DEAN HA, MAYLE JE: Gender Differences in Manning Criteria in the Irritable Bowel Syndrome. Gastroenterology 1991; 100:591-595. (PDF)
SMITH RC, GARDINER JC, ARMATTI S, JOHNSON M, LYLES JS, GIVEN CW, LEIN C, GIVEN B, GODDEERIS J, KORBAN E, HADDAD R, KANJ M: Screening for High Utilizing Somatizing Patients Using a Prediction Rule Derived from the Management Information System of an HMO – Apreliminary study: Medical Care 2001; 39:968-978 (PDF)
SMITH RC, KORBAN E, KANJ M, HADDAD R, LEIN C, GARDINER JC, LYLES JS, HODGES A, DWAMENA FC, COFFEY J, COLLINS C: A method for Rating Charts to Identify and Classify Patients with Medically Unexplained Symptoms. Psychother Psychosom, 2003; 73:36-42. (PDF)
SMITH RC, GARDINER JC, LUO Z, ROST K: Diagnostic Accuracy of Predicting Somatization from Patients’ ICD-9 Diagnoses. Psychosom Med, 2009; 71:366-371. (PDF )

High Rate of Mental Health Problems in Medical Settings

SMITH RC, GARDINER JC, LYLES JS, SIRBU C, DWAMENAV FC, HODGES A, COLLINS C, LEIN C, GIVEN CW, GIVEN B, GODDERIS J: Exploration of DSM-IV Criteria in Primary Care Patients with Medically Unexplained Symptoms. Psychosom Med, 2005; 67:123-129. (PDF)
DWAMENA FC, LAIRD-FICK H, FREILICH L, D’MELLO D, FREY J, DASARIA A, GRAYSON-SNEED KA, SOLOMON D, SMITH RC: Behavioral Health Problems in Medical Patients. JCOM, 2014: 21:497-505. (PDF )

Cost-effectiveness of Primary Care Providers Using the MHCM

LUO Z, GODDEERIS J, GARDINER JC, LYLES J, SMITH RC: Costs of an Intervention for Primary Care Patients With Medically Unexplained Symptoms: A Randomized Controlled Trial. Psychiatric Services, 2007; 58:1079-1086. (PDF)

Costs for a Train-the-Trainer Program

LUO Z, GARDINER J, SMITH RC: Costs of a Train-the-Trainer Program to Teach Primary Care Faculty Mental Health Care. Medical Care. 2021, 59:970-974. (PDF)

Screening for Opioid Misuse

SMITH RC, FRANK C, GARDINER JC, LAMERATO L, ROST KM: Pilot Study of a Preliminary Criterion Standard for Prescription Opioid Misuse. American Journal on Addictions, 2010; 19;523-528 (PDF)

Minor Acute Illness

SMITH RC, GARDINER JC, LYLES JS, JOHNSON M, ROST KM, LUO Z, GODDEERIS J, LEIN C, GIVEN CW, GIVEN B, DWAMENA F, COLLINS C, Van Egeren LF, Korban E, Kanj M, Haddad R: Minor Acute Illness: A Preliminary Research Report on the ‘Worried Well.’ J Fam Pract 2002; 51:24-29. (PDF)

VII. Team-Based Approaches

LEIN C, COLLINS C, LYLES JS, HILLMAN D, SMITH RC: Building Research Relationships with Managed Care Organizations: Issues and Strategies. Families, Systems, and Health. 2003; 21:205-214. (PDF)
LAIRD-FICK H, DWAMENA FC, RAWSTHORNE LL, JODOIN C, ALEXANDER K, BANKER T, SOLOMAN D, GOURINENI N, FRANKEL RM, ALOKA F, SMITH RC: Training residents and nurses to work as a patient-centered care team on a medical ward. Patient Education and Counseling; 2011; 84:90-97. (PDF)