Please note that the Central Policy Committee have extended the
currency of this report to 2015, following review by the working
group in 2011/2012.
Joint report between the Royal College of Psychiatrists
and the Royal College of General Practitioners.
This report aims to highlight the importance of
improving the management of individuals with both physical and
psychological problems in primary care. Depression and anxiety are
common in physical illness, yet, mental health services are
separated from physical health services with separate commissioning
processes, targets and service boundaries.
As commissioning arrangements in England change, this report takes
the opportunity to contribute positively to the provision of
needs-led integrated services for people with both comorbid
physical and mental health needs – as these individuals often fall
through the funding gap between physical and mental health
commissioners.
Most liaison psychiatry has traditionally been hospital-based, but
as health services in England change, with more individuals
receiving their treatment in primary care, liaison services can
provide valuable support to GPs and Tier 2 services, in addition to
acute hospital work.
A general practitioner (GP) is usually the first health
professional to whom people turn when they develop symptoms. The
report has been written as a practical guide to improve the
detection and management of psychological issues and problems in
the context of diagnosing and managing physical illness in the
primary care setting. It is jargon-free, yet full of useful
professional guidance and advice. Twelve overall recommendations
and five action points are given. GP registrars and trainee
psychiatrists should find it helpful.
The report is divided into three sections: Person, Process and
Practitioner. In all three, ‘patient-centred bio-psychosocial
model’ of care is presented – it tries to move away from a
mind/body dichotomy and present an approach based on successful
clinical practice and supported by a strong body of research.
Contents
Executive summary, recommendations and action
points
Introduction
Part I Person
1. Mind and body: normal responsiveness and
mechanisms
2. Concepts and definitions
3. Psychological response to physical
illness
4. Depression
5. Medically unexplained symptoms in primary
care
Part II Process
6. Using the doctor–patient relationship to
the benefit of doctors and patients
7. Assessment and shared decision-making:
managing mind and body
8. Management and treatment of psychological
problems associated with physical illness
Part III Practitioner
9. Training
10. Looking after yourself
11. Inter-professional teamworking
12. Referral to specialist care and developing
services
References