The extraordinary potential of primary care to improve mental health.

Abstract

Mental health service in primary care has traditionally been viewed as the Cinderella of the health system. Mental illness contributes 12% to the global burden of disease, yet European countries spend on average about 5% of their health budget on mental health care.1 The new European Community member states spend an even smaller proportion of their health budgets on mental health services, perhaps around 2%.1 In the last few years, however, mental health services in primary care attracted considerable interest and the importance of mental illness in primary care became apparent. Nine out of ten depressed patients are treated only in primary care.2 Over three quarters of patients consulting their general practitioner admit to at least one psychosocial problem, over one third report that psychosocial problems impact on their present health,3 and up to two thirds of suicide victims contact a general practitioner in the four weeks before their death.4 In addition, the general public, surveyed more than a decade ago, preferred to see general practitioners rather than psychiatrists for depression and to receive psychological treatments and counselling rather than drug treatment.5 This perhaps indicates that seeing a psychiatrist is still associated with considerable stigma, but also provides primary care professionals with an opportunity to engage patients effectively. The realisation of the importance of mental health led to numerous recent developments and initiatives both in the UK and internationally. Three of those appear to be especially pertinent for primary care.