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