Health services research on mental health in primary care

Objective: The article seeks to provide an international perspective on the facilitating role of health services research in the treatment of psychiatric disorders in primary care. It builds on Goldberg and Huxley's model describing pathways to mental care for the psychiatrically ill in the community. Method: Seventy studies were selected for review by Medline search, sixteen studies by contacting prominent researchers in the field. All studies are discussed more or less extensively. Results: Case identification strategies including screening tools and diagnostic modules have been developed. Other strategies include educational training programs and psychiatric consultation services designed to facilitate psychopharmacological and other types of treatment of psychiatric disorders in primary care. Several models for the linkage of primary care and specialty mental health providers are discussed, and a primary care psychiatry programme is examined. Conclusion: Better psychiatric training of general practitioners (GPs), on-site consultation, and better communication between mental health professionals and GPs can improve the recognition, management, and referral of psychiatrically ill primary care patients. The further development of guidelines focusing on anxiety disorders, somatization, subthreshold disorders, and effectiveness in primary care is recommended.