Foreword to first edition

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 whom.

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 handbook aims to ameliorate this problem. The diagnostic and management summaries 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 handbook 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. We support this handbook and hope that its use improves communication and collaboration between all who have a stake in the provision of good primary mental healthcare.

Dr John Cox
President, Royal College of Psychiatrists

Claire Rayner
President, Patient’s Association

Professor André Tylee
Director, Royal College of General Practitioners Unit for Mental Health Education in Primary Care

Christine Hancock
President, Royal College of Nursing