Recognition and treatment of mental illness in primary care: Towards a better understanding of a multifaceted problem

Abstract

The work of Olfsen et al. in the current issue of General ~~s~f~2 Ps~c~~~~ (pp. 173-180) emphasizes once more that mental disorder often remains unrecognized in primary care settings. They show that nondetection is associated with misperception of poor (general) health; i.e., physically healthy patients who misperceive their health as poor often suffer from emotional distress which is rarely detected by the primary care physician (PCP). Olfsen et al. correctly stress the misleading nature of the concept of the “worried well,” as this easily gives rise to the false assumption that these patients do not suffer from any (mental) problem and consequently do not need any care. The study of Olfsen et al. adds a new facet to the already complicated problem of nonreco~tion of mental illness in primary care settings. Nonrecognition is to some extent a collusive phenomenon, as it serves the interests of both patient and PCP [1,2]. For both of them, nondiscussion of psychological and social problems may be an easy way out. It saves patients from facing their problems and from possible shame and guilt accompanying assuming responsibility; it saves PCPs from taking more detailed history and from the delicate management of psychosocial problems, for which they may have not been trained, and which they expect to consume too much time.