Psychiatry in primary care 

At one time, it was asserted that the ‘worried well’ were treated in primary care, while true mental illnesses were seen by the mental illness services. This was not true when it was asserted, and is even less true now. The great majority of patients with common mental disorders are cared for within primary care, and many of those with severe mental illnesses are only seen in primary care. ‘Stepped care’ is a model for distributing clinical problems between the services, and ‘shared care’ refers to the care of patients seen by both primary care and specialist mental health services. Many other workers in primary care now assist GPs with the treatment of mental disorders, and special administrative arrangements within primary care are necessary to ensure that clinical services are available to those with special needs. In summary, mental disorders in primary care: ♦ Are an important public health problem ♦ Frequently present with somatic symptoms ♦ Are more likely to be detected if the doctor has better communication skills ♦ Those with disabling physical illnesses are also at greater risk ♦ Are on average less severe than those seen in specialist care