Abstract
The government white paper Health of the nation has highlighted mental health as a key issue for the next decade. Primary care is being encouraged to take a leading role in developing effective services for people with mental health problems. This paper reviews current research on key aspects of mental health in adults: the prevalence of mental health problems, improving detection and management of mental health problems, the role of counselling, and communication between primary and secondary care. Recommendations are made for initiatives in both research and service development.
Full text
PDF




Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aldridge D. Spirituality, healing and medicine. Br J Gen Pract. 1991 Oct;41(351):425–427. [PMC free article] [PubMed] [Google Scholar]
- Bebbington P., Hurry J., Tennant C., Sturt E., Wing J. K. Epidemiology of mental disorders in Camberwell. Psychol Med. 1981 Aug;11(3):561–579. doi: 10.1017/s0033291700052879. [DOI] [PubMed] [Google Scholar]
- Beck A. T., Hollon S. D., Young J. E., Bedrosian R. C., Budenz D. Treatment of depression with cognitive therapy and amitriptyline. Arch Gen Psychiatry. 1985 Feb;42(2):142–148. doi: 10.1001/archpsyc.1985.01790250036005. [DOI] [PubMed] [Google Scholar]
- Beckman H. B., Frankel R. M. The effect of physician behavior on the collection of data. Ann Intern Med. 1984 Nov;101(5):692–696. doi: 10.7326/0003-4819-101-5-692. [DOI] [PubMed] [Google Scholar]
- Bennett C. The Worcester development project: general practitioner satisfaction with a new community psychiatric service. J R Coll Gen Pract. 1989 Mar;39(320):106–109. [PMC free article] [PubMed] [Google Scholar]
- Bridges K. W., Goldberg D. P. Somatic presentation of DSM III psychiatric disorders in primary care. J Psychosom Res. 1985;29(6):563–569. doi: 10.1016/0022-3999(85)90064-9. [DOI] [PubMed] [Google Scholar]
- Briscoe M., Wilkinson G. General practitioners' use of community psychiatric nursing services: a preliminary survey. J R Coll Gen Pract. 1989 Oct;39(327):412–414. [PMC free article] [PubMed] [Google Scholar]
- Brown L. M., Tower J. E. Psychiatrists in primary care: would general practitioners welcome them? Br J Gen Pract. 1990 Sep;40(338):369–371. [PMC free article] [PubMed] [Google Scholar]
- Burns T. Community ward rounds. Health Trends. 1990;22(2):62–63. [PubMed] [Google Scholar]
- Carr A. Compliance with medical advice. Br J Gen Pract. 1990 Sep;40(338):358–360. [PMC free article] [PubMed] [Google Scholar]
- Cooper C. L., Rout U., Faragher B. Mental health, job satisfaction, and job stress among general practitioners. BMJ. 1989 Feb 11;298(6670):366–370. doi: 10.1136/bmj.298.6670.366. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Copeland J. R., Dewey M. E., Wood N., Searle R., Davidson I. A., McWilliam C. Range of mental illness among the elderly in the community. Prevalence in Liverpool using the GMS-AGECAT package. Br J Psychiatry. 1987 Jun;150:815–823. doi: 10.1192/bjp.150.6.815. [DOI] [PubMed] [Google Scholar]
- Corney R. H. Counselling in general practice--does it work? Discussion paper. J R Soc Med. 1990 Apr;83(4):253–257. doi: 10.1177/014107689008300416. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cox J. L., Holden J. M., Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987 Jun;150:782–786. doi: 10.1192/bjp.150.6.782. [DOI] [PubMed] [Google Scholar]
- Creed F., Marks B. Liaison psychiatry in general practice: a comparison of the liaison-attachment scheme and shifted outpatient clinic models. J R Coll Gen Pract. 1989 Dec;39(329):514–517. [PMC free article] [PubMed] [Google Scholar]
- Davenport S., Goldberg D., Millar T. How psychiatric disorders are missed during medical consultations. Lancet. 1987 Aug 22;2(8556):439–441. doi: 10.1016/s0140-6736(87)90970-6. [DOI] [PubMed] [Google Scholar]
- Deys C., Dowling E., Golding V. Clinical psychology: a consultative approach in general practice. J R Coll Gen Pract. 1989 Aug;39(325):342–344. [PMC free article] [PubMed] [Google Scholar]
- Donnan P., Hutchinson A., Paxton R., Grant B., Firth M. Self-help materials for anxiety: a randomized controlled trial in general practice. Br J Gen Pract. 1990 Dec;40(341):498–501. [PMC free article] [PubMed] [Google Scholar]
- Dowell A. C., Biran L. A. Problems in using the hospital anxiety and depression scale for screening patients in general practice. Br J Gen Pract. 1990 Jan;40(330):27–28. [PMC free article] [PubMed] [Google Scholar]
- Dowrick C., Graham-Jones S., Stanley I. Mental health in the community. Med Educ. 1992 Mar;26(2):145–152. doi: 10.1111/j.1365-2923.1992.tb00140.x. [DOI] [PubMed] [Google Scholar]
- Dowrick C. Who will be 'caring for people'? Br J Gen Pract. 1992 Jan;42(354):2–3. [PMC free article] [PubMed] [Google Scholar]
- Dowrick C. Why do the O'Sheas consult so often? An exploration of complex family illness behaviour. Soc Sci Med. 1992 Mar;34(5):491–497. doi: 10.1016/0277-9536(92)90204-4. [DOI] [PubMed] [Google Scholar]
- Earll L., Kincey J. Clinical psychology in general practice: a controlled trial evaluation. J R Coll Gen Pract. 1982 Jan;32(234):32–37. [PMC free article] [PubMed] [Google Scholar]
- Essex B., Doig R., Rosenthal J., Doherty J. The psychiatric discharge summary: a tool for management and audit. Br J Gen Pract. 1991 Aug;41(349):332–334. [PMC free article] [PubMed] [Google Scholar]
- Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
- Freeling P., Rao B. M., Paykel E. S., Sireling L. I., Burton R. H. Unrecognised depression in general practice. Br Med J (Clin Res Ed) 1985 Jun 22;290(6485):1880–1883. [PMC free article] [PubMed] [Google Scholar]
- Gabe J., Williams P. Women, housing, and mental health. Int J Health Serv. 1987;17(4):667–679. doi: 10.2190/XEBC-5R7Y-8WA6-D4WP. [DOI] [PubMed] [Google Scholar]
- Gask L., Goldberg D., Lesser A. L., Millar T. Improving the psychiatric skills of the general practice trainee: an evaluation of a group training course. Med Educ. 1988 Mar;22(2):132–138. doi: 10.1111/j.1365-2923.1988.tb00423.x. [DOI] [PubMed] [Google Scholar]
- Gask L., McGrath G., Goldberg D., Millar T. Improving the psychiatric skills of established general practitioners: evaluation of group teaching. Med Educ. 1987 Jul;21(4):362–368. doi: 10.1111/j.1365-2923.1987.tb00377.x. [DOI] [PubMed] [Google Scholar]
- Graham H., Senior R., Lazarus M., Mayer R., Asen K. Family therapy in general practice: views of referrers and clients. Br J Gen Pract. 1992 Jan;42(354):25–28. [PMC free article] [PubMed] [Google Scholar]
- Groves T. What does community care mean now? BMJ. 1990 Apr 21;300(6731):1060–1062. doi: 10.1136/bmj.300.6731.1060. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Holden J. M., Sagovsky R., Cox J. L. Counselling in a general practice setting: controlled study of health visitor intervention in treatment of postnatal depression. BMJ. 1989 Jan 28;298(6668):223–226. doi: 10.1136/bmj.298.6668.223. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hollyman J. A., Freeling P., Paykel E. S., Bhat A., Sedgwick P. Double-blind placebo-controlled trial of amitriptyline among depressed patients in general practice. J R Coll Gen Pract. 1988 Sep;38(314):393–397. [PMC free article] [PubMed] [Google Scholar]
- Hooper P. D. Psychological sequelae of sexual abuse in childhood. Br J Gen Pract. 1990 Jan;40(330):29–31. [PMC free article] [PubMed] [Google Scholar]
- Horder E. Care for patients discharged from psychiatric hospital. Br J Gen Pract. 1991 Oct;41(351):399–400. [PMC free article] [PubMed] [Google Scholar]
- Howells G. Down's syndrome and the general practitioner. J R Coll Gen Pract. 1989 Nov;39(328):470–475. [PMC free article] [PubMed] [Google Scholar]
- Howells G. Mental handicap--care in the community. Br J Gen Pract. 1991 Jan;41(342):2–4. [PMC free article] [PubMed] [Google Scholar]
- Howie J. G., Porter A. M., Heaney D. J., Hopton J. L. Long to short consultation ratio: a proxy measure of quality of care for general practice. Br J Gen Pract. 1991 Feb;41(343):48–54. [PMC free article] [PubMed] [Google Scholar]
- Iliffe S., Booroff A., Gallivan S., Goldenberg E., Morgan P., Haines A. Screening for cognitive impairment in the elderly using the mini-mental state examination. Br J Gen Pract. 1990 Jul;40(336):277–279. [PMC free article] [PubMed] [Google Scholar]
- Iliffe S., Haines A., Gallivan S., Booroff A., Goldenberg E., Morgan P. Assessment of elderly people in general practice. 1. Social circumstances and mental state. Br J Gen Pract. 1991 Jan;41(342):9–12. [PMC free article] [PubMed] [Google Scholar]
- Jacobson N. S., Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991 Feb;59(1):12–19. doi: 10.1037//0022-006x.59.1.12. [DOI] [PubMed] [Google Scholar]
- James A. Homeless women in London: the hostel perspective. Health Trends. 1991;23(2):80–83. [PubMed] [Google Scholar]
- Johnstone A., Goldberg D. Psychiatric screening in general practice. A controlled trial. Lancet. 1976 Mar 20;1(7960):605–608. doi: 10.1016/s0140-6736(76)90415-3. [DOI] [PubMed] [Google Scholar]
- Kendrick T., Sibbald B., Burns T., Freeling P. Role of general practitioners in care of long term mentally ill patients. BMJ. 1991 Mar 2;302(6775):508–510. doi: 10.1136/bmj.302.6775.508. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kessler R. C., House J. S., Turner J. B. Unemployment and health in a community sample. J Health Soc Behav. 1987 Mar;28(1):51–59. [PubMed] [Google Scholar]
- Kessler R. C., Neighbors H. W. A new perspective on the relationships among race, social class, and psychological distress. J Health Soc Behav. 1986 Jun;27(2):107–115. [PubMed] [Google Scholar]
- Klerman G. L. The current age of youthful melancholia. Evidence for increase in depression among adolescents and young adults. Br J Psychiatry. 1988 Jan;152:4–14. doi: 10.1192/bjp.152.1.4. [DOI] [PubMed] [Google Scholar]
- Livingston G., Sax K., Willison J., Blizard B., Mann A. The Gospel Oak Study stage II: the diagnosis of dementia in the community. Psychol Med. 1990 Nov;20(4):881–891. doi: 10.1017/s0033291700036588. [DOI] [PubMed] [Google Scholar]
- Lowry S. Housing and health: Families and flats. BMJ. 1990 Jan 27;300(6719):245–247. doi: 10.1136/bmj.300.6719.245. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mann A. H., Jenkins R., Belsey E. The twelve-month outcome of patients with neurotic illness in general practice. Psychol Med. 1981 Aug;11(3):535–550. doi: 10.1017/s0033291700052855. [DOI] [PubMed] [Google Scholar]
- Marshall M. Collected and neglected: are Oxford hostels for the homeless filling up with disabled psychiatric patients? BMJ. 1989 Sep 16;299(6701):706–709. doi: 10.1136/bmj.299.6701.706. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Marshall M., Gath D. What happens to homeless mentally ill people? Follow up of residents of Oxford hostels for the homeless. BMJ. 1992 Jan 11;304(6819):79–80. doi: 10.1136/bmj.304.6819.79. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Matthews K., Eagles J. M. Which antidepressant? Br J Gen Pract. 1991 Mar;41(344):123–125. [PMC free article] [PubMed] [Google Scholar]
- Mayfield D., McLeod G., Hall P. The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry. 1974 Oct;131(10):1121–1123. doi: 10.1176/ajp.131.10.1121. [DOI] [PubMed] [Google Scholar]
- McLean J., Pietroni P. Self care--who does best? Soc Sci Med. 1990;30(5):591–596. doi: 10.1016/0277-9536(90)90157-n. [DOI] [PubMed] [Google Scholar]
- Melzer D., Hale A. S., Malik S. J., Hogman G. A., Wood S. Community care for patients with schizophrenia one year after hospital discharge. BMJ. 1991 Oct 26;303(6809):1023–1026. doi: 10.1136/bmj.303.6809.1023. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Millar T., Goldberg D. P. Link between the ability to detect and manage emotional disorders: a study of general practitioner trainees. Br J Gen Pract. 1991 Sep;41(350):357–359. [PMC free article] [PubMed] [Google Scholar]
- Milner G., Hassall C. Worcester Development Project: the closure and replacement of a mental hospital. Health Trends. 1990;22(4):141–145. [PubMed] [Google Scholar]
- Nietzel M. T., Russell R. L., Hemmings K. A., Gretter M. L. Clinical significance of psychotherapy for unipolar depression: a meta-analytic approach to social comparison. J Consult Clin Psychol. 1987 Apr;55(2):156–161. doi: 10.1037//0022-006x.55.2.156. [DOI] [PubMed] [Google Scholar]
- O'Dowd T. C. Five years of heartsink patients in general practice. BMJ. 1988 Aug 20;297(6647):528–530. doi: 10.1136/bmj.297.6647.528. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pokorny A. D., Miller B. A., Kaplan H. B. The brief MAST: a shortened version of the Michigan Alcoholism Screening Test. Am J Psychiatry. 1972 Sep;129(3):342–345. doi: 10.1176/ajp.129.3.342. [DOI] [PubMed] [Google Scholar]
- Power K. G., Simpson R. J., Swanson V., Wallace L. A. Controlled comparison of pharmacological and psychological treatment of generalized anxiety disorder in primary care. Br J Gen Pract. 1990 Jul;40(336):289–294. [PMC free article] [PubMed] [Google Scholar]
- Priest R. G. A new initiative on depression. Br J Gen Pract. 1991 Dec;41(353):487–487. [PMC free article] [PubMed] [Google Scholar]
- Pullen I. M., Yellowlees A. J. Scottish psychiatrists in primary health-care settings. A silent majority. Br J Psychiatry. 1988 Nov;153:663–666. doi: 10.1192/bjp.153.5.663. [DOI] [PubMed] [Google Scholar]
- Rand E. H., Badger L. W., Coggins D. R. Toward a resolution of contradictions. Utility of feedback from the GHQ. Gen Hosp Psychiatry. 1988 May;10(3):189–196. doi: 10.1016/0163-8343(88)90018-7. [DOI] [PubMed] [Google Scholar]
- Renvoize E., Clayden D. Can the suicide rate be used as a performance indicator in mental illness? Health Trends. 1990;22(1):16–20. [PubMed] [Google Scholar]
- Richards J. P. Postnatal depression: a review of recent literature. Br J Gen Pract. 1990 Nov;40(340):472–476. [PMC free article] [PubMed] [Google Scholar]
- Rowland N., Irving J., Maynard A. Can general practitioners counsel? J R Coll Gen Pract. 1989 Mar;39(320):118–120. [PMC free article] [PubMed] [Google Scholar]
- Scott A. I., Freeman C. P. Edinburgh primary care depression study: treatment outcome, patient satisfaction, and cost after 16 weeks. BMJ. 1992 Apr 4;304(6831):883–887. doi: 10.1136/bmj.304.6831.883. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shapiro D. A. Science and psychotherapy: the state of the art. Br J Med Psychol. 1980 Mar;53(1):1–10. doi: 10.1111/j.2044-8341.1980.tb02862.x. [DOI] [PubMed] [Google Scholar]
- Shepherd M. Primary care psychiatry: the case for action. Br J Gen Pract. 1991 Jun;41(347):252–255. [PMC free article] [PubMed] [Google Scholar]
- Sorby N. G., Reavley W., Huber J. W. Self help programme for anxiety in general practice: controlled trial of an anxiety management booklet. Br J Gen Pract. 1991 Oct;41(351):417–420. [PMC free article] [PubMed] [Google Scholar]
- Tennant C., Bebbington P., Hurry J. The short-term outcome of neurotic disorders in the community: the relation of remission to clinical factors and to "neutralizing' life events. Br J Psychiatry. 1981 Sep;139:213–220. doi: 10.1192/bjp.139.3.213. [DOI] [PubMed] [Google Scholar]
- Timms P. W., Fry A. H. Homelessness and mental illness. Health Trends. 1989 Aug;21(3):70–71. [PubMed] [Google Scholar]
- Tyrer P., Seivewright N., Murphy S., Ferguson B., Kingdon D., Barczak P., Brothwell J., Darling C., Gregory S., Johnson A. L. The Nottingham study of neurotic disorder: comparison of drug and psychological treatments. Lancet. 1988 Jul 30;2(8605):235–240. doi: 10.1016/s0140-6736(88)92535-4. [DOI] [PubMed] [Google Scholar]
- Tyrer P., Seivewright N., Wollerton S. General practice psychiatric clinics. Impact on psychiatric services. Br J Psychiatry. 1984 Jul;145:15–19. doi: 10.1192/bjp.145.1.15. [DOI] [PubMed] [Google Scholar]
- Wallace P. Linking up with the over 75s. Br J Gen Pract. 1990 Jul;40(336):267–268. [PMC free article] [PubMed] [Google Scholar]
- Waydenfeld D., Waydenfeld S. W. Counselling in general practice. J R Coll Gen Pract. 1980 Nov;30(220):671–677. [PMC free article] [PubMed] [Google Scholar]
- Wilson D. N., Haire A. Health care screening for people with mental handicap living in the community. BMJ. 1990 Dec 15;301(6765):1379–1381. doi: 10.1136/bmj.301.6765.1379. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wooff K., Goldberg D. P. Further observations on the practice of community care in Salford. Differences between community psychiatric nurses and mental health social workers. Br J Psychiatry. 1988 Jul;153:30–37. doi: 10.1192/bjp.153.1.30. [DOI] [PubMed] [Google Scholar]
- Wright A. F., Perini A. F. Hidden psychiatric illness: use of the general health questionnaire in general practice. J R Coll Gen Pract. 1987 Apr;37(297):164–167. [PMC free article] [PubMed] [Google Scholar]
