Book Review - Delivering mental health care

Dr Brian Marien explains why this book is a timely and essential addition to any general practice library.

Delivering Mental Health in Primary Care is a useful resource for GPs. It provides up-to-date, straightforward information on the identification, classification and management of people with mental health problems.

Given the prevalence of psychological problems in the general population, the arrival of this book is particularly timely.

GPs often witness the devastating impact of mental health problems, the personal suffering, occupational disadvantage and impairment of family and interpersonal relationships.

Patients with anxiety and depression often run a chronic relapsing course, use primary and secondary care services extensively, and can incur high health costs due to prolonged disability. The GP's knowledge, understanding and involvement are central to the well-managed care of patients.

While it is important to identify and treat mental health problems early and effectively, it is also imperative that we do not over-diagnose, or 'pathologise' normal human emotions.

Labelling, and particularly psychiatric labelling, can create its own set of problems including stigma and embarrassment.

Common disorders
Somatisation and somato-form disorders, covered in the chapter on 'Common mental health problems', are particularly relevant to primary care. Medically unexplained physical symptoms are common, accounting for 30-50 per cent of all consultations.

The subjective experience of illness is not easily divided into physical and mental domains. GPs, with their generalist skills, and their ability to routinely bridge the mind-body divide, are in the best position to take the lead on developing the care pathway for medically unexplained physical symptoms.

If we want to move to an integrated model of care it is essential that we do not leave the conceptual framework solely to psychiatrists or specialist physicians.

Dr Alan Cohen, the book's editor, states in his introduction: 'The prevention, identification and management of all mental health conditions are the responsibility of primary care.'

This is a really big ask. It is estimated that of the 280 million consultations in primary care last year, a third had a significant mental health component and 90 per cent of mental health problems are treated in primary care alone.

There is a real danger that GPs find themselves 'between a rock and a hard place' with pressure to diagnose and treat large numbers of patients with mental health problems in the absence of appropriate support systems.

In the past, sometimes the 'gates' have been closed and the whole responsibility for clinical care has remained with the GP.

Good clinical care of patients with mental health problems requires both time and skill. The last chapter of the book looks at the challenges of educating and training a primary care mental health workforce. This is essential if the goal of improving outcomes for patients with psychological problems is to be met.

This book has arrived at an important time for delivery of mental healthcare in primary care and is an essential addition to the practice library.

  • Dr Marien is a former GP and specialist in psychological medicine in West Sussex
Book giveaway

GP and the RCGP are giving away five copies of Delivering Mental Health in Primary Care: an evidence-based approach, edited by Dr Alan Cohen, worth £24.95 each.

For a chance to win a copy visit

If you are unlucky in the draw you can order a copy from the Healthcare Republic bookstore at

It is also available from the RCGP bookshop. Online: Phone: (020) 7344 3198. RCGP members receive a 10 per cent discount when ordering this book.


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