In a general-practice surgery, every third or fourth
patient seen has some form of mental disorder. Levels
of disability among primary care patients with such
disorders are high; greater on average than disability
among primary care patients with common chronic diseases
such as hypertension, diabetes, arthritis and back pain.
Simple effective treatments are available for many mental
disorders and some can be treated more effectively than
hypertension or coronary heart disease.
Changes in the way services are provided also emphasize
the importance of primary care as a setting for mental
healthcare. Over the past 30 years, the number of hospital
beds available for people with mental illness has fallen,
while the number of GPs and psychiatrists has risen.
A direct result is that people in primary care need
to work more closely with those in mental health services.
Good mental healthcare is a collaborative effort. The
Primary Care Team includes practice nurses, district
nurses, health visitors, counsellors, clinical psychologists
and school nurses, as well as GPs, all of whom may have
a role in mental healthcare. The Community Mental Health
Team may include nurses, occupational therapists, clinical
psychologists, social workers and support workers, as
well as psychiatrists. Families and friends, self-help
and community groups also provide crucial support to
people with a whole range of mental disorders: from
transient distress to enduring psychotic illness. They
need to talk to one another, respect each other's contribution
and jointly agree who will provide which service to
Despite this, mental health provision has been dogged,
perhaps more than any other area of healthcare, by differences
in how we think about mental health and the words we
use. This makes it hard for different professional groups
and non-professionals to talk to each other. This web
site aims to ameliorate this problem. It presents guidelines for some common neurological and mental disorders. The diagnostic and management summaries relating to mental disorders which it contains are based on the WHO International Diagnostic and Management Guidelines for Mental Disorders in Primary Care and are wholly compatible with ICD-10 Chapter V which is the diagnostic framework used by psychiatric professionals. However,
they have been simplified and extensively piloted to
ensure that they are relevant to primary care. They
also include management strategies based on a multiaxial
approach emphasizing the information needs of patients
and their families, and simple social and psychological
management strategies, in addition to medication.
This web site is a resource that can be used in a number
of ways. It can be used by an individual practitioner
in the care of his or her patients; it can also be used
by a primary care team or a primary care organization
(or local health group) to review, jointly with mental
health teams, the service they provide, identifying
gaps and training needs or developing locally appropriate,
shared criteria for referral to specialist services.
It is hoped that this web site improves communication
and collaboration between all who have a stake in the
provision of good primary mental healthcare.
Copies of the second edition of the WHO guide to mental
and neurological health in primary care are available
from RSM Press, priced £22.50.
your copy now.