90 per cent of people with mental health problems cared for within primary care

Dr Liz England, Mental Health Clinical Champion 

Mental health has, and always will be an important part of general practice. As General Practitioners we often provide mental health care as part of our holistic role.

This mental health position statement can help clarify the current roles and responsibilities of the primary healthcare team considering recent policy changes and developments. It recognises that many of the recommendations can only take place if appropriate resources are provided. The statement considers the role of general practice in managing patients in the community, mental health problems and long-term conditions, parity of esteem of mental and physical health, inter-professional working as well as training and education.

Mental health problems are common. One in six adults and one in ten children are likely to have a mental health problem in any year. Antidepressant prescribing has doubled in a decade. An average GP list of 2000 patients will have (at any one time):

  • 352 people with a common mental health problem
  • 8 with psychosis
  • 120 with alcohol dependency
  • 60 with drug dependency
  • 352 with a sub-threshold common mental health problem
  • 120 with a sub-threshold psychosis
  • 176 with a personality disorder
  • 125 (out of the 500 on an average GP practice list) with a long-term condition with a comorbid mental health problem
  • 100 with medically unexplained symptoms not attributable to any other psychiatric problem (MUS).

90% of people with mental health problems are cared for entirely within primary care, which includes people with serious and enduring mental illness (SMI) but primary care uses less than 10% of the total expenditure spent on mental health. Around 30% of people who see their GP have a mental health component to their illness.

Providing care for people with mental health problems and promoting mental health is a priority for the NHS in each of the four countries of the UK.

General practice, which is part of wider primary care, is charged with providing care for 'common mental health problems' and contributing to health promotion,11 through the GP Contract, commissioned by NHS England but there is a lack of clarity around roles and responsibilities for the care of patients with chronic, complex and disabling non-psychotic mental health problems.

Primary care also has a duty to provide physical health care including offering screening, to those people with SMI such as schizophrenia. However, there is no clear direction as to who should manage people with stable SMI who no longer require the expertise of specialist secondary care services. Many of these people are being discharged into primary care with no planning or support.

Primary care is in a unique position to deliver mental health care being most people's first port of call in times of health care need or the development of symptoms. It is the only part of our health service that offers 'cradle to grave' family orientated, person-centred care, often seeing and supporting patients through significant life events such as pregnancy and bereavement.

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