Primary Mental Healthcare and Integrated Services (original) (raw)

2012, Mental Illnesses - Evaluation, Treatments and Implications

Mental disorder, which ranges in prevalence from 4.3 to 26.4% a year worldwide, is a critical healthcare issue (Demyttenaere et al., 2004). It is a leading cause of morbidity. Its cost and impact on productivity and on individual and family quality of life are substantial. It is associated with greater stigmatization of individuals, family burden, and a range of risk factors (for example, poverty, social isolation, criminal behavior, tobacco use, suicide attempts). Along with addiction, it is a major cause of work absenteeism and accounts for more lost work days in Canada than physical ailments (Kirby, 2006). Given the longstanding impact of mental disorder, the World Health Organization (WHO, 1978; 2001; 2008), emulated by countries such as Australia, New Zealand, the United Kingdom, and Canada (Smith, 2009), has advocated primary care reinforcement as a leading priority in mental healthcare. Primary care is defined as "the provision of first contact, person-focused, ongoing care over time that meets the health-related needs of individuals, referring only those too uncommon to maintain competence, and coordinated care when individuals receive services at other levels of care" (Starfield, 2008, p. 5). Usually, mental disorders that are considered to be managed in primary care are well-defined disorders, for which there are effective pharmacological and psychological treatments (Bower, 2002). Robust primary care systems are deemed to achieve better organizational and patient outcomes (Starfield et al., 2005). Compared to specialized care, they are considered to be more accessible, less stigmatizing, and more comprehensive since they manage physical problems along with mental disorder (Rothman & Wagner, 2003). Studies report that most patients with chronic conditions prefer receiving services in primary care if the quality of services is perceived as good (Upshur & Weinreb, 2008). According to Heymans (2005), primary healthcare should handle 90% of health problems. As the main entry and service point for primary healthcare (Bambling et al., 2007), general practitioners constitute the cornerstone of the system. Every year, an estimated 75 to 80% of the general population consult a general practitioner (Nabalamba & Millar, 2007), with up to a third of these visits for a mental disorder (Rockman et al., 2004). General practitioners see more patients with mental disorders than psychiatrists do. In Canada, about 10% of the population seek mental healthcare yearly: 45% of these patients consult a general practitioners; and 25%, other healthcare practitioners (Lesage et al., 2006