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The mental health of physicians in training is a topic of considerable concern. Recent attention to the issue of patient safety has led to examination of the relationship between residents’ stress and compromised clinical performance. Few mental health programs dedicated to residents and formally structured to meet their specific needs are reported in the literature. The authors raise the question of why there are so few programs and why more residents don't take advantage of services that do exist. They then describe the development and utilization of the University of Michigan Health System's House Officer Mental Health Program. The program was structured to overcome barriers to utilization such as lack of funding, concerns about confidentiality, ease of access and residents’ financial constraints and to provide comprehensive services for a wide range of diagnoses. Data are presented on the first four years of operation from 1997–01 that show increasing utilization and high levels of satisfaction over this time period by house officers at all levels of training and in all departments of the Health System. As increasing attention is paid to how to deal with medical errors, the establishment of such programs should be considered, not only as a means to address the general mental health of residents but also as an appropriate venue to deal with the stress that can contribute to and be induced by medical mishaps.