Psychiatry in General Practice

Abstract

Mental illnesses and substance use disorders are responsible for an enormous amount of disability and mortality on their own, but even more so indirectly through poor health decision-making. In the Western world, much of the health burden stems from chronic conditions including obesity, hypertension, diabetes, and heart disease. These primarily result from chronic behaviors including unhealthy diet, lack of exercise, poor sleep habits, and substance use. Behind these are often depression and anxiety. These problems exist despite ready access for most people to medical, and to a lesser extent, mental health care. In the rest of the world, access to mental health education and resources can be much more limited, or even absent. Globally, only a small fraction of general practice patients are properly identified, diagnosed, or treated for mental health conditions. Due to the vast shortage of specialty mental health providers worldwide, primary care providers have become the de facto mental health providers for the last several decades, despite lacking the education or support needed to properly do so. It has been agreed upon for decades that in order to improve patient care, decrease cost, and increase patient satisfaction, a total system redesign is needed. The system needs to shift toward whole person or patient-centered care. The principles of collaborative and integrated mental health care have been crafted over many years in order to specifically solve for these problems. Multiple international organizations have demonstrated that these new care delivery systems can be adapted to, and effective in, just about any location in the world. In order to apply these innovations, though, primary care providers across the world need more training in psychiatry, and psychiatry providers, in general medicine. Through a growing body of innovative programs in general practice, there is now the opportunity to do so. Highlighted training programs in the United State include the University of Washington, Yale, and the Universities of California at Davis and San Francisco. Organizations include the Agency for Health Research and Quality, the Institute of Medicine, the American Academy of Psychiatry Residency Training Directors, and the Association for Medicine and Psychiatry in America. Internationally, work by the World Health Organization, the World Organization of Family Doctors, the Programme for Improvement of Mental Health Care, and the Emerging mental health systems in low and middle-income countries research consortium are examined.