The meeting opened with an eloquent speech from Dr. David Satcher. He began by noting, in particular, the diversity of the participants including business, health care systems, consumers, families, and foundations, as well as government agencies. He was particularly impressed with the balanced presence of primary care and mental health experts who were well established in their fields. These experts included "real world" and "front line" people who would be key to helping solve some of the unfortunate barriers within our current health care system. He then challenged the participants to think beyond each of their individual perspectives and consider ways to overcome barriers between primary care and mental health. He noted that many golden opportunities exist for integrating mental health services and primary care.

He presented his thoughts regarding the highlights of the Millis report on the role of primary providers (Millis, 1966). That report identified a number of roles for primary care providers. They included providing first contact of care, providing comprehensive care, providing the coordination and integration of care, and providing community leadership.

Dr. Satcher acknowledged, as a family physician, both the frustrations and opportunities presented to the primary care provider on a daily basis. As the Surgeon General he pronounced the evidence in 1999 in Mental Health: A Report of the Surgeon General and the need to create a system of care that not only treats illness but also promotes health. He named building a balanced community health system as one of his top three national priorities. A balanced community health system balances health promotion, disease prevention, early detection, and universal access. This system concept would require a partnership between primary care and mental health and between public health and medicine.

Primary care offers golden opportunities as a point of first contact with patients and their families, in which a meaningful relationship can be established to educate and motivate patients, as well as to detect health conditions. A "balanced partnership" provides an opportunity for the coordination and integration of patient care. This is actualized by involving the health team and the family and targets continuity of care, which ensures comprehensive high-quality care.

Dr. Satcher addressed specifically the lack of time in primary care that providers have to adequately attend to the many responsibilities that our health care systems require of them. He urged primary care providers to remember that they are not alone. In fact, he challenged the primary care provider to be the quarterback of the health care team that collaboratively makes the system work for the patients and their families. He spoke of our negligence of the health care system for not engaging the potential resources available within families. Not only is family involvement therapeutic for the patient, but it is the key to sustaining continuity of care and providing high-quality care.

He then encouraged providers to act as responsible community leaders who educate, motivate, and mobilize the public regarding the definition of mental health as stated in Mental Health: A Report of the Surgeon General. He went on to define mental health as a person's ability to function and to be productive in life; to adapt to changes in his/her environment; to cope with adversity; and to develop positive relationships with others. He emphasized that without good mental health one cannot have good health and well being. Therefore the primary care and mental health partnership is crucial for overall balanced health.

The good news in the mental health report, he indicated, is that we have the ability, perhaps 80 to 90 percent of the time, to treat mental disorders with a range of different treatments. However, the bad news is that less than half who suffer each year seek treatment. And many who make contact with the health system don't necessarily make contact with the mental health system because they are experiencing mental illness, because they are unaware, or because of the stigma surrounding mental illness. Others have trouble because of barriers associated with the health care system itself.

Dr. Satcher moved on to ask what is the vision for the future and what is the task ahead. He then pointed out that Mental Health: A Report of the Surgeon General devoted an entire chapter to laying a vision for the future. He went on to identify the eight courses of action in that chapter to include the following:

• Our work should be based on the best available science so that we may prevent disease and promote good mental and physical health. Thus, we must continue and enhance mental health research, especially prevention and promotion.
• We must acknowledge and find ways to overcome the barriers of stigma.
• We need to build public awareness regarding mental health and effective treatments.
• We must address the serious shortage of mental health providers and the lack of training available for many community helpers who could potentially impact a person's health.
• We need to ensure the delivery of state-of-the-art treatment which means moving front-line knowledge to front-line care so that primary care providers have access to knowledge, technology and teams of experts to support their work with their patients and families.
• We need to tailor treatment to age, gender, race, and culture.
• We need to facilitate entry into treatment.
• We need to remove the financial barriers that create complexity and restrictions within our health care system.

Dr. Satcher ended with a quote from John Gardner, Secretary of Health, Education, and Welfare in the 1960s, "Life is full of golden opportunities carefully disguised as irresolvable problems."