11 - Unmet need for management of mental disorders in primary care

Summary

This chapter analyses the unmet need for management of mental disorders in primary care. It is written in light of the World Health Organization (WHO) Collaborative Study ‘Psychological Problems in General Health Care’, which was conducted in 14 countries. It focuses on the importance of primary care for mental health care; the definition of need; the current state of mental disorders in primary care; and implications for research and training. Three main parameters were utilized in the definition of need:

1. Clients. Mental health researchers have focused mainly on diagnosis to define need. However, primary care attenders and providers focus mainly on complaints that relate to daily functioning. While a diagnosis of the condition is necessary for the management of the patient, diagnosis alone does not provide the basis for understanding the patient's need. Both patients and primary care providers utilize the functioning/disability framework to make their encounter more meaningful.

2. Providers. For many providers, mental health problems are a nonissue: they are not considered a real problem, nor are they seen as remediable. Most primary care providers are not adequately trained or equipped with skills to manage mental health problems.

3. Services. Provision for need in primary care has often been seen as a result of the interaction between the client and the provider. However, the way the services are structured (e.g., appointment system, length of visit, numbers of patients, personal doctors) determines how a patient's needs can be expressed or modulated.

A new framework that uses models of the way the service functions is needed to understand the management of mental health problems in primary care.