Chapter 18 - Psychiatry in Primary Care

Summary

The psychiatry of primary care, and the work that GPs do, has expanded as a field of interest for psychiatrists beyond its early roots in epidemiological research and studies into the detection of mental disorders by general practitioners. An understanding of the key role of the primary care team in managing often-complex mental health problems in the wider community as well as how to work effectively at the interface in partnership and joint work with GPs is essential not only for general adult psychiatrists but other specialists too – as policy makers, both local to the UK and internationally, continue to recognise its importance. The Pathways to Care model provides a useful framework for understanding how the prevalence of mental illness in the community (particularly for common mental disorders such as anxiety and depression) is distributed and how this changes according to the way that health care systems are organised. Ways of working include collaborative care, social prescribing, brief psychological therapy – including CBT-guided self-help – and antidepressants (although controversies surround their usage), with suicide prevention, shared care with CMHTs and training and education of both groups being prominent issues.