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The Royal College of Psychiatrists Improving the lives of people with mental illness

CR152. The Management of Patients with Physical and Psychological Problems in Primary Care

Price: £0.00

Approved: Jun 2008

Published: Jan 2009

Status: current

Number of pages: 126

Review by: 2015

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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.


Executive summary, recommendations and action points



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



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