primary rather than secondary care and the general practitioner (GP) has traditionally been the first port of call for patients. Other members of the primary care team are working with various degrees of autonomy, which means that patients’ appointments are increasingly likely to be with a primary care professional other than a GP, such as a practice nurse, nurse practitioner, healthcare assistant, health visitor or midwife. This means that all members of the primary care team will be seeing patients with common mental disorders, especially if they are comorbid with physical illness. All these professionals are therefore well placed to recognise and deliver brief evidence-based mental health interventions to the patients they see, to refer on as appropriate and thereby to reduce some of the primary care workload. Depending on models of local healthcare provision, general practices will have referral systems available for patients both within and outside of primary care. Models of mental healthcare vary throughout the UK and internationally but, despite this, there are key professionals who work with patients with mental health problems under the umbrella of primary care. These typically include counsellors, primary care mental health workers, psychologists and gateway workers. In the 1980s and early 1990s, community psychiatric nurses (CPNs) became more frequently involved in primary care mental health work (Boardman, 1997). This shift away from working exclusively within specialist services and towards general practice collaboration has subsequently been reversed. Since the mid-1990s, in response to policy development and professional review (Audit Commission, 1994; Department of Health, 1994, 1995), the work of these nurses has been realigned with specialist services working within multidisciplinary teams. There have been large increases in the mental health nursing workforce – a 21% increase in head-count over the 10 years to 2006 (Department of Health, 2006) – but the major focus of this workforce is upon the needs of patients with severe and enduring mental illnesses, primarily schizophrenia.
This chapter examines current and potential mental healthcare roles primarily of practice nurses, as the majority of research has been carried out with this group. However, work has also been undertaken with midwives and health visitors and research is emerging that is focusing on the roles of district nurses. Therefore the role of these groups of professionals are also discussed.