James W. Hunt Jr.’s Aug. 9 letter (“Community health centers offer a model of how to fix ailing US system” ) is important, but it leaves out a major aspect of health care that is costing the taxpayer and government needless dollars. The history of separating mental health from the rest of health care (known as a carve-out) is responsible for the lack of integration of mind and body into a coherent approach to the health and illness of the population.

About 50 percent of Americans will have a mental health problem during their lifetime, and by some estimates, half of primary care visits are related to mental health or substance use disorders.


Our government splits mental health from medical care (with a separate Department of Mental Health and Department of Public Health), decreasing the effectiveness of care, and increasing costs. Pharmacy management companies and vendors for mental health that is paid for by Medicaid skim profits off the top of federal, state, and private insurance dollars that could otherwise be spent on prevention and treatment.

The same edition of the Globe depicts payment for a severe childhood disorder that costs millions (“Life-changing treatment, heartbreaking choices,” Page A1), while mental health care is the only industry in the United States expected to operate at a continual loss. Without significant changes, we will fail to provide effective, cost-containing care over the long run. Yearly budgets do not address the total cost of care over a lifetime. Only early investment of prevention, assessment, and treatment, and a significant, functioning continuum of care, can reduce total medical expenses. Pay now or pay much more later.

Dr. Marshall Forstein

Acting chair of psychiatry

Cambridge Health Alliance