In this issue of the Companion, Brenda Reiss-Brennan, M.S., A.P.R.N., C.S., and colleagues offer what we consider an important new area of competency evaluation for primary care medicine—that of family relationship competencies. While conceptual in framework, relationship competence training (RCT), with its interventional assessment and profiling tool, represents leading-edge thinking in the area of health care delivery and as a future outcomes measure. A decade of emphasis in primary care interventions for those with mental illness has produced mixed results. Mere symptomatic improvement recorded by standardized scales for depression or anxiety does not necessarily correlate with improvements in function. Indeed, recent research in depression treatment suggests that, in terms of social functioning, only those with full illness remissions will match non-ill controls.1 Additionally, only persons attaining illness remission will avoid the high rates of relapse and recurrence associated with partial treatments. The goal of treatment is robust, sustained improvement and the restoration or acquisition of normal functioning. Clinicians and third-party payers alike are now demanding such evidence of effectiveness in measures of functional outcome from pharmaceutical companies, managed care companies, and others involved in the development and implementation of treatments delivered to patients. What better outcome could we anticipate (and demand) than improvements in the relationships that are key to health and satisfaction with life? Surely, improving these relationships is a herculean task, but Reiss-Brennan and her colleagues are on the road and making progress. RCT as conceptualized by Reiss-Brennan et al. is a component of an integrated delivery system for mental health services. Such integration seeks to make the recognition, assessment, and management of mental distress and illness a seamless part of everyday practice in primary care. Integrated delivery systems offer two potential benefits—medical cost offsets and improvements in patient and clinician satisfaction—all proceeding from the understanding that mental illness, not somatic illness per se, is responsible for most patient presentations. Clinicians as a whole have made significant gains over the last decade in the recognition of mental illness. What is missing in our practice setting are teams of collaborators ready to address these needs at the time of presentation, supporting each other in practice, combined with sources of reimbursement to make this model of care self-sustaining. Stakeholders will necessarily make concessions to achieve integrated care delivery. We believe that any loss of autonomy will be more than compensated by the benefits of honoring the realities of primary care with a system designed to address those realities. To do otherwise is to remain cut off from the truth.