Abstract

our years ago, when the Mental Health Review last focused on primary care, we took a ‘swift journey over the extensive ground of primary care and mental health’ (Pidd & McArthur, 2000). That review was written when only the 17 first-wave PCTs were in existence, most PCGs were still moving towards PCT status, and much of the landscape that has become familiar since the publication of Shifting the Balance of Power (Department of Health, 2001) had yet to develop. At that time, taking an overview of the key challenges facing primary care organisations in respect of mental health services and how those issues were being addressed, we felt cautiously hopeful. We recognised the continuing cultural differences between primary and secondary care mental health services and that considerable work was needed on several fronts to develop consistent and effective primary mental health care. Primary care organisations were still establishing themselves and shaping up to their role, and were frequently hampered by limited person power. Nonetheless, we cautiously acknowledged a period of new opportunities to re-engineer care, while recognising that it might be some time before PCTs would be in a position to drive forward the primary mental health care agenda. Where are we now? The intervening period has seen further relentless modernisation in primary care and in mental health services. For the NHS as a whole, we have probably reached the closest approach, however imperfect, to a ‘primary care-led NHS’ that we have yet seen. Are we still travelling hopefully toward a bright future for primary mental health care? Or has conservatism ‘in the system’ (and consequently, cynicism) inevitably set in? To a degree the wealth of material within this issue answers the question. The articles attest to a wide range of developmental work in primary mental health care, F contributing to the improvement of services and to better practice. They also illustrate the increasing profile of primary mental health care. It is no longer the poor relation, rarely getting attention and airspace, but is now firmly on the agenda and part of the mainstream discourse. A brief look at developing primary mental health care, and at PCT commissioning of mental health services, should help to determine how far we have travelled and how promising the current ‘state of the nation’ is.

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