Mental health in the community: roles,responsibilities and organisation of primary care and specialist services

UK health policy embodies two opposing trends affecting mental health care in the community: a move towards a primary care-led NHS which inevitably reflects the concern of GPs with 'milder' mental illness, and specific mental health policies intended to refocus the specialist services on people with 'serious' mental illness. A training needs assessment study undertaken with primary care staff and community psychiatric nurses revealed the problems created on the ground by these opposing trends. This paper describes these problems from the perspectives of three groups: primary care nurses, general practitioners (GPs) and community psychiatric nurses (CPNs). The overall impression was of primary care teams encountering high levels of need for which they felt unprepared, and of a CPN service torn in two by the opposing demands of GPs and their employing trust. The discussion section of the paper compares the findings of the study with a model for reorganisation put forward in the literature and highlights the obstacles to be overcome in bridging the policy gap.