Primary care

Mental disorder is extremely common. Therefore no country, however rich it might be, can afford anything approaching sufficient specialist personnel to see and care for everyone with a mental disorder. Most people with mental disorders will need to be seen and cared for by members of the primary health care unit. (44) It is therefore essential to strengthen the basic and continuing training of the various members of the primary health care unit by knowledge of assessment, diagnosis, management, and criteria for referral of people with mental disorders to secondary care. This is as essential in the developed world as it is in low-income countries. (45)

In the development of policy on the primary care of mental illness it is important to examine the existing primary care system, its staffing, its system of basic and continuing training for each of the professional groups involved, and the existing system of information collection from primary care. Key questions for consideration in the development of policy on primary care include the following.

1. What does the basic training for each tier and professional in the primary care unit consist of and how much, if any, mental health is included?

2. What continuing training is available for each tier?

3. How much mental health is included in the regular continuing training?

4. What quality monitoring of standards in primary care exists?

5. How far is the work of the primary care team proactive or reactive?

Primary care policy for mental health will need to set out the goals and mechanism by which the existing primary care system will incorporate a substantial mental health component into its work in a systematic way, supported by (a) appropriate basic and continuing training and by the development and use of good practice guidelines, (b) regular meetings with specialist staff to discuss criteria for referral, discharge letters, needs for medicines, shared care, and any other co-ordination issues, and (c) adequate data collection. Adequate planning is not possible without good systems for information collection in primary care. In Iran the health workers routinely collect basic data every year on the prevalence and outcome of the priority disorders which include infectious diseases, schizophrenia, epilepsy, depression, and anxiety. This data is summarized into an annual table and displayed on the wall of the health centre so that it is readily available to all staff who have the data and its implications for their work at their fingertips and so that it can be compared with preceding years.

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