Loosening the Bond: Mental Health Psychiatry and Primary Care
| DOI | https://doi.org/10.1108/13619322199600024 |
| Date | 01 September 1996 |
| Published date | 01 September 1996 |
| Pages | 5-7 |
| Author | Anne Rogers |
| Subject Matter | Health & social care |
The Mental Health Review 1:3 ©Pavilion Publishing (Brighton) 1996 5
Anne Rogers, Ph.D., Reader in Sociology
NATIONAL PRIMARY CARE RESEARCH AND DEVELOPMENT
CENTRE, UNIVERSITY OFSALFORD
The boundaries between primary and
secondary care are changing and new
models of working in mental health are
being sought. The general shift towards a primary-
care-driven NHS has been reinforced by the
community-orientated emphasis in recent mental
health policy.The latter entails significant changes
in roles and responsibilities for primary care workers
in the provision of, and arrangements for,careand
needs assessment. Yet despite the new opportunities
that these changes bring, there is a risk that
innovation will be overshadowed by the narrow
concerns of traditions imported from secondary care
services. This might stifle the development of new
approaches to mental health which have emerged
from within primary care, as well as inhibiting the
incorporation of a lay and user perspective and new
partnerships being forged between lay people and
primary care workers.
GPs – ‘inferior’ psychiatrists?
Traditionally, GPs have assumed a subordinate role
to psychiatrists. This asymmetrical relationship is
predicated on the notion that psychiatrists, as
specialists in mental health, ‘know best’ in terms of
knowledge and clinical competence. This assumption
about the relative incompetence of GPs is associated
with the view that they regularly fail to recognise
morbidity in their patients. It has also led to the
caution that their diagnoses areless valid or reliable
than those made by specialists. Psychiatrists are
more enthusiastic than GPs to instigate earlier
admission to hospital and utilise hospital day treat-
ment for depressed patients.1This is consistent with
psychiatrists’ assumptions that GPs arepoorly aware
of their proactive responsibilities towards patients in
terms of both diagnosis and treatment.2In accordance
with this attributed GP inferiority, psychiatrists have
assumed a largely self-appointed educative role in
primary health care. They have put particular efforts
into developing techniques, such as diagnostic inter-
viewing, and they have constructed new psychiatric
measurement devices for use by other professionals.
From a psychiatric vantage point, this new
pedagogic role in primary care is viewed as warranted
and enabling. It is assumed that psychiatric input
will improve the careof patients and that, at the
same time, the skills of GPs and other primary care
workers will be enhanced. However, it would be
wrong to assume that the view about a ‘superior’
role of specialists is shared by GPs or service users.
There has been a less than enthusiastic response
from some GPs, who view the relationship between
themselves and psychiatrists as an unequal and
increasingly irrelevant one. Many are now forming
preferred relationships with other mental health
workers, such as clinical psychologists, counsellors
and social workers.3The increasingly cost-conscious
GP might also query whether liaison psychiatry is
cost-effective compared to input from CPNs,
counsellors, clinical psychologists and social workers.
Of course, many individual GPs will find the input
of liaison psychiatrists helpful. They can provide:
advice about medication; personal supportfor GPs
struggling with ‘difficult-to-manage’ patients; and,
most importantly, access to resources, especially
hospital admission. However, even heretheir bene-
ficial role cannot be taken for granted. Psychiatrists,
like GPs, have not escaped criticism over irrational
prescribing (polypharmacy and mega-dosing4, 5).
Loosening the Bond: Mental Health
Psychiatry and Primary Care
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