Previous research has demonstrated a reduction in utilization of medical services following the initiation of psychiatric services for certain patients. The phenomenon has been called the offset effect. The authors investigated the offset effect in a Veterans Administration medical center setting. They found that the offset effect emerged only for patients who had high rates of use of medical services who received mental health services for 1 year or less. They discuss factors related to higher rates of medical care utilization as well as important differences between the present and previous research that require further study.