Psychiatry in primary care using the three-stage assessment

Abstract

• Mental illness imposes a massive burden on all levels of service, including primary care.
• Challenges particular to primary care include the overwhelming service loads and time/resource constraints.
• A further challenge revolves around the frequent mismatch between undergraduate teaching and the clinical nature of psychiatric care in primary level clinics.
• Clinical presentations at primary level are often nonspecific and undifferentiated, and complicated by comorbid medical illness and psychosocial stressors.
• The three-stage assessment that embraces the core principles of family practice can be adapted to incorporate the psychiatric needs of patients in primary care and deliver a truly holistic and integrated assessment of their individual needs.
• These adaptations need not involve additional training or the need for additional clinical tasks.
• Psychiatric management requires continuity of care within an enduring therapeutic relationship, which provides the ideal framework within which a comprehensive assessment and management plan can be formulated.
• Successful adaptations to the three-stage assessment could provide an effective (and efficient) model for the integration of psychiatry at the primary care level.