Quality improvement in primary care mental health practice. A case for political intervention?

Improving the quality and consistency of detecting and providing for so-called common mental health problems in primary care settings is a contemporary issue. Such conditions are common and they are now recognised as a significant burden upon the economy. Though energetically pursued for much of the last half century, a medical approach based upon syndromal diagnosis and treatment has not provided a clear, evidence-based approach to their management that can form the basis of an educational intervention. Where that has been attempted and evaluated, it has been found wanting. A more politically driven imperative has stimulated 'top-down' and firmly managed processes of change, encouraged by fresh investment. Improving Access to Psychological Therapies will not be the first programme to influence mental health services in this way. Experience of other programmes of deliberately managed change suggests that this approach can be effective and productive, particularly in a context which mental health exemplifies, where there are relatively few clinical certainties and a multitude of opinions.