Primary care is key to changing the high rates of physical illness amongst people with severe problems and promoting recovery.
Two thirds of people with severe problems are seen by a combination of primary and specialist services and a third only in primary care:
- Annual GP consultation rates for the latter in a recent study were 3 per annum compared to 2.8 for the general practice population as a whole59.
- Practice nurses, with a key role in cardiovascular risk screening and health education, consulted with this population about once a year on average compared with the population rate of 1.8 consultations per year59.
- Problem-based interviewing had a positive effect on the detection and management of common mental health problems presenting in primary care60-62. Evaluation of training primary care physicians to manage severe problems in the community suggested that this increased referral rates to secondary care63 whilst a further study saw no effect64.
- Placement of social workers in primary care can be successful65 but mental health facilitators or ‘hand-held’ records shared between primary and secondary care seem not to be61
- People with common mental disorders improved markedly overall whether referred to community nurses trained in problem solving or for their usual care or not66
- Collaborative care between primary care, psychiatrists and care managers does have demonstrable efficacy in common mental disorders67