Mental health intervention programs in primary care: their scientific basis

This study examines the scientific basis for mental health intervention programs in primary care. The validity of five underlying assumptions is evaluated, using the results of a naturalistic study covering a representative sample of 25 Dutch family practices and data from the literature. Our findings corroborate the validity of the assumptions. Firstly, our study indicates that mental disorders are indeed very prevalent in primary care settings. Secondly, we find that a substantial proportion of mental disorders is not recognized by the general practitioner (GP). Thirdly, our data show that mental disorders in primary care are not transient or self-limiting. Fourthly, it is shown that only half of the GP attenders with a mental disorder receive some form of mental health treatment in the 14 months after their index consultation. Finally, our data suggest that mental disorders, when identified, can be treated effectively in primary care. These findings are in general agreement with the literature. In the discussion we underscore the need for public health intervention programs targeted at primary care providers. Training programs for general physicians must be directed at improving recognition and diagnosis and at enhancing the availability and quality of mental health interventions. The effectiveness of these programs has to be tested in randomized trials.