|Home | About | Journals | Submit | Contact Us | Français|
The two papers by Lester, et al1,2 describe studies on the role of the new ‘graduate workers’ in primary care mental health. In Luton, for some years, we adopted a model of using a team of more experienced nurses and social workers to act as links between primary care practices and mental health services. The theory behind this model has been described elsewhere.3
The role of these primary care mental health workers was conceived as acting as a liaison link with the CMHTs? and other secondary mental health services, and also to give advice to the GPs on the management of mental health problems, always referring to the consultant psychiatrist as necessary. They were also expected to offer CBT and other interventions to some of the patients in the GP's surgery. They were expected to be seen as an integral part of the GP team, accessing the GP computer system. It was hoped that they would facilitate the rapid referral of early psychotic patients, seriously suicidal patients and other difficult cases to secondary services.
In practice, this team of workers were very effective in helping GPs manage depression in primary care. They attended CMHT meetings, and were seen as part of the CMHTs, as well as being primary care workers, therefore they served as a useful link between the GPs and the CMHTs, particularly the psychiatrists, ensuring rapid transfer of information between primary and secondary care about difficult cases, and implementing necessary action.
For early intervention in psychosis, this team did prove very effective.4 This was because the team members were very experienced, and could pick up relatively minor abnormalities in mental state. They were then able to contact the doctor in charge of the early intervention for psychosis service directly, in order to arrange an assessment within a few days.
Out of the first 86 referrals to the early intervention service, 12 came by this route. Of these, 11 entered the service as new psychotic patients. The success of this team, which is no longer extant, depended on the great experience of its staff. It remains unclear what forms of mental health problems in primary care are likely to receive effective treatment from the ‘graduate mental health workers’.