Treatments of primary care team

For acute disorders

Acute problems are generally treated with counseling alone or combined with medication. Some practices also provide simple behavioral treatments. Since general practitioners seldom have time to provide counseling for all those who would benefit from it, the primary care team often includes a counselor. With additional training, practice nurses can take on this role effectively (Wilkinson et al. 1993). The availability of a counselor has not been shown to reduce the prescribing of psychotropic drugs in the practice (Mynors - Wallis et al. 1995; Sibbald et al. 1996b); however, medication and counseling often have complementary roles.

For chronic disorders

The respective roles of the general practitioner and the community team should be defined clearly in relation to each patient with chronic mental disorder, and reviewed regularly. For example, in the care of some patients with chronic schizophrenia, the general practitioner might care for physical health, assess general progress, administer and encourage compliance with medication, and support the family. Kendrick et al. (1995) found that even with additional training, general practitioners are not very effective in making structured assessments of patients with long term psychiatric illness. It is generally better that the psychiatric team assess those patients, and agree a. plan with the general practitioner. This plan will include elements provided by the psychiatric team, and elements provided by the primary care team, such as the administration of medication, support for the family, and general medical care.

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