Primary care mental health
This book is about primary care mental health, a concept that has emerged relatively recently in the history of healthcare.
The World Health Organization (WHO) has defined ‘primary care mental health’ to incorporate two aspects (WHO & Wonca, 2008):
• first-line interventions that are provided as an integral part of general Healthcare
• mental healthcare that is provided by primary care workers who are skilled, able and supported to provide mental healthcare services.
Doctors have provided emotional care in the form of support, advice and comfort for their patients for centuries, alongside other professional, spiritual and lay workers, friends and families. However, in the past 40 years or more in the UK, since the pioneering research carried out by first by the husband and wife team of Watts & Watts (1952) and later by John Fry (Fry, 1960), within their own practices, and by Michael Shepherd and his colleagues at the General Practice Research Unit in London (Wilkinson, 1989), there has been a particular interest in the mental healthcare that is provided within primary and general healthcare settings by a range of professionals who are not specialists in mental health. In that time, the focus of both research and development has shifted and changed in a number of different ways: from an emphasis on detection of disorders, towards better ‘chronic disease’ management; from the general practitioner (GP) working alone to the partnership between the doctor, the extended primary care team and the local community; from the narrow focus of research on the behaviour of the doctor towards an exploration of the view of the patient; and, in policy terms, a shift from viewing the GP as an ‘independent’ agent towards increasing attempts to influence the decisions that he or she makes in the assessment and management of mental health problems and the promotion of good mental health.
Many of these changes are encapsulated in the change of terminology from ‘psychiatry and general practice’, the title of the forerunner to this publication, which was jointly published by the Royal Colleges of Psychiatry and General Practice over a decade ago (Pullen et al, 1994), to a broader view of ‘primary care mental health’ (from the title of this publication now commissioned by the Royal College of Psychiatrists) reflecting the wider involvement of a range of health professionals in primary and specialist settings.