Mental health in primary care

Today we know that early identification, regular follow-up and quality mental health care can prevent suffering and deterioration. However, too often the fear of stigma and the lack of confidence in the treatment and of trust in the clinician ultimately inhibit people’s willingness to seek care. Addressing these barriers through an effective primary care is the starting point for improving adherence to and the success of mental health care.

These messages are highly emphasized in the WHO European Action Plan. Modern mental health services are no longer the exclusive responsibility of psychiatry. On the contrary, more collaborative and coordinated partnerships should be established and actions should be taken to favour community care that guarantees people with mental disorders receive the respect, safety, trust and effective care they deserve. 

Although most people seeking help for mental health problems start with the family doctor, such problems often go undetected and untreated. Educating and training primary health care staff are therefore essential to shifting mental health services from traditional hospital-based care into mainstream health care in the community.

This shift has wide-ranging benefits.

  • People can access mental health services closer to their homes. This keeps families together, maintaining their daily activities, and prevents the indirect costs of seeking specialist care in distant locations.
  • Mental health care delivered in primary care minimizes stigma and discrimination, and removes the risk of human rights violations that occur in psychiatric hospitals.
  • Integrating mental health services into primary care generates good health outcomes at reasonable cost. General primary care systems must be strengthened, however, before this integration can be expected to flourish.

Facts and figures

Most countries report that general practitioners (GPs) deal with common mental health problems:

  • identifying and referring people with problems (95% of countries);
  • diagnosing problems (86%);
  • regularly treating people with common disorders (86%).

GPs play a major role in identification, diagnosis and referral for severe mental disorders, but in most countries specialists are expected to give treatment, with GPs playing a supportive role.

  • 74% of countries report that GPs identify and refer people with severe and enduring mental health problems.
  • 52% report that GPs diagnose such disorders: 11 of the 15 countries belonging to the European Union (EU) before May 2004 (73%) and 5 of the 12 countries that joined the EU afterwards (42%).
  • 40% report GPs give treatment; this includes no countries in south-eastern Europe or newly independent states. 

The challenge 

  • A shift from traditional hospital-based mental health services into mainstream health care in the community requires that family doctors become competent in assessment, detection, treatment and referral when required.
  • National mental health policies should recognize and address the broader factors that promote mental health, such as socioeconomic and environmental factors. This requires mainstreaming mental health promotion in the education, employment, justice, transport, environment, housing and welfare sectors, where local and national decision-makers’ choices may have unintended consequences for mental health.

WHO response

The WHO European Mental Health Action Plan (2013) addresses the need for integration of mental health in primary care and the expansion of mental health education in primary care curricula.

Objective 3 states: ‘Mental health services are accessible, competent and affordable, available in the community according to need.’

The Plan focuses on expanding the role of primary care, working in partnership with multidisciplinary mental health staff in community-based facilities. It encourages Member States to establish primary care as the first point of access for people with mental health problems and provide the capacity to deliver treatment for common mental disorders.