Why primary care?
There is worldwide consensus on the importance of integrating mental health into primary care. Such integration is now viewed as the most effective way to foster the needed holistic biopsychosocial approach, as well as specific services, for people with mental health and addiction problems in the primary care setting. Meeting people's needs requires a continuum of services, from health promotion and prevention, to assessment and early identification, to treatment and prompt referral when appropriate, to active recovery and rehabilitation support.
Primary care is both a point along the continuum and a reflection of what the continuum can deliver. It offers a unique opportunity for improving access to health services and health outcomes, as well as preventing stigma and discrimination and promoting well-being at every age.
The irony of primary care settings is that although they are the venue where most people get their health care, they are also the place where many mental illness and substance use issues go undiagnosed and untreated. This reality lends urgency to the global imperative to enhance mental health and addiction services within primary care through ongoing training and resource support, as well as through transformative practice approaches.
Principles for Integrating Mental Health into Primary Care
There are many perspectives on what constitutes comprehensive, effective integration of mental health into primary care. The following key considerations have guided the authors' integration initiatives:
- Integration is a dynamic process and should be based on the specific context of each case, including needs and gaps, strengths, opportunities, culture and diversity, as well as equity as a fundamental guiding principle for succesfull integration and effective provision of health care services.
- An integrated, comprehensive approach includes health promotion, prevention, early detection, treatment and rehabilitation. It should address the ongoing needs of clients from childhood through to old age.
- The complexity of each case can best be captured using a biopsychosocial model. The potential diagnosis of a mental health issue would be more apparent to teams using such a framework when presented with common somatic symptoms for which no underlying medical etiology can be established. Conversely, the physical root of mental health symptoms is also more likely to be identified.
- Screening for concurrent mental illness and substance use problems is essential, given the significant prevalence of co-occurring disorders.
- Psychosocial factors that might affect treatment compliance and success should be considered and addressed early.
- Interprofessional and intersectoral approaches for care are incorporated or fostered through a recovery model.
- An anti-stigma/anti-discrimination strategy should inform all levels of care, as well as the comprehensive recovery approach.
- Planning, evaluating and monitoring are essential tools for effective decision making.
- Capacity should be built at all levels for maximum impact and efficacy.
- Practitioners should engage in alternative self-care practices in order to promote their own health and prevent harms to themselves.