title: Unmet need for mental health and addictions care in urban community health clinics: frontline provider accounts.
abstract: OBJECTIVE
  To facilitate planning to improve care delivery in community health clinics, this study provides an in-depth description of the social, cultural, and organizational factors that create the context for mental health and addictions treatment delivery in this setting.
  
  
  METHODS
  Seventeen community health clinic providers and personnel were interviewed for 45-90 minutes with open-ended questions to elicit the context of their frontline provider experiences. Major themes and subthemes of responses were identified with content analysis.
  
  
  RESULTS
  Issues that create significant barriers to care included complex patient comorbidity and demographic characteristics; clinic organization, resources, and funding shortfalls; communication barriers with specialty mental health and addictions agencies; and stigmatizing aspects of mental health, addictions, and disadvantaged status.
  
  
  CONCLUSIONS
  The unique barriers to care in the community health care setting, as well as the unique characteristics of patients served, are likely to require context-specific solutions. These solutions will determine the viability of existing chronic disease management models, such as collaborative care, when applied to this setting.
authors.affiliation: Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), Department of Psychiatry, University of Washington School of Medicine at Harborview Medical Center, Seattle, WA 98104-2499, USA.
authors.forename: Meg
authors.initials: M
authors.lastname: Cristofalo
authors.forename: Doris
authors.initials: D
authors.lastname: Boutain
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Schraufnagel
authors.forename: Kristin
authors.initials: K
authors.lastname: Bumgardner
authors.forename: Doug
authors.initials: D
authors.lastname: Zatzick
authors.forename: Peter P
authors.initials: PP
authors.lastname: Roy-Byrne