Part I - Conceptual basis and overarching themes

Summary

The seven chapters in Part I cover a range of fundamental concepts and provide the keys to understanding much of the rest of the book. They highlight a series of interesting themes, including the fundamental and growing importance of primary care mental health, but also the problems inherent in its delivery, as well as the importance of context and the tension in encouraging service users to have a choice and a voice within a wider system that tends to exclude people with mental health diagnoses.

We start by asking a fundamental question – what is primary care mental health? This first chapter provides an overview of the concept and describes the range of relevant policy initiatives in this area, the types of mental health problems seen and treated in primary care and strategies that are being used nationally and internationally to improve integration across the interface between primary and secondary care. The international focus is continued with a chapter on primary care mental health in low- and middle-income countries and a thoughtful essay by Sartorius, informed by 40 years of work on the world stage, on the extent to which and manner in which treatment of mental disorders and their prevention differ between settings.

The chapters on the epidemiology and the classification of mental illness in primary care both highlight the complexities of primary care mental health. Describing the rates of disorder within primary care, for example, is difficult, since it is almost impossible to obtain a representative sample of primary care physicians to collaborate with a research team. Patients in primary care are also much less likely to present with clearly identifiable diagnostic syndromes, which affects both the classification process and the epidemiological evidence base. Understanding these issues sheds light on the apparent under-diagnosis of many mental health problems by primary care practitioners.

Perhaps above all, Rogers and Pilgrim in Chapter 4, looking through a critical sociological lens, capture the spirit of many chapters in Part I by suggesting that primary care has moved from the margins to the mainstream and now represents a new and central field of the management of mental health in society.