By | 1 May, 2019

Around 90% of people with mental health problems receive their care in the primary care setting. In addition to that, the majority of those people who receive care in specialist services also receive physical health care from their GP and practice team.

Yet, despite the central role that primary care plays in providing mental health services, there is still a lack of recognition of the importance of ‘primary care mental health’ in mental health care, and many people working in primary care still feel very under-prepared for the task.

Less than half of GPs have had specific training in psychiatry, and a recent editorial in the BMJnoted that recently qualified GPs feel particularly unskilled in managing mental health problems of children and young people, and a majority of practice nurses feel ill-equipped to deal with mental health.

What has changed over the last decade is that many more medical students are getting experience of primary care mental health during their training, and psychiatry posts for young doctors in Foundation and Vocational Training are being better tailored to the needs of a future more likely to be spent in general practice than in a specialty psychiatry post. GP registrars always told me that they learned far more that was useful to them as future GPs in liaison psychiatry jobs in the general hospital and old age psychiatry, than in general psychiatry in-patient posts.

However, what might be particularly helpful would be if we could break down the barriers and have more psychiatrists also train in the community – in ‘primary care mental health’. Because psychiatrists and other mental health professionals don’t get enough training in primary care either, and many specialists simply don’t have enough understanding of the pressures and problems of working there.

When I worked with a primary care based mental health team, our therapists had the relative luxury of half an hour to see a new patient. When a specialist registrar came to spend some time with us, and I asked him to try working to half hourly appointments to understand the pressures he was horrified. ‘I cannot see a new patient in less than an hour!’ he said. To which I replied, ‘Can you imagine how it is for a GP then – working to 10-minute appointments.’

e-Learning courses can now make training in mental health much more accessible for everyone working in the primary care setting- increasing knowledge, challenging and attitudes and introducing new skills and ways to work and practice. They can provide a valuable way to introduce information and be part of a ‘blended’ learning approach combining different ways of providing training.

At a local level, any face to face training sessions are best provided by GPs, mental health professionals and patients/service users working together, must be specifically tailored for the needs of audience and are better when locally relevant (for example- comparison information on how local referral and prescribing practices across GP clusters varies – which always makes for lively discussion!).

Training needs to start early if it is going to be effective for medical students, GP registrars, psychiatric trainees and practice nurses. At the postgraduate level it is best provided as close to the place of work as possible for greater take-up. I generally found that only 10% of the possible audience came to a face-to-face course, and often they were the ones who could also have been co-tutors. This is one of the ways e-learning can be particularly helpful by potentially increasing uptake due to its flexibility and convenience.

Mental health consultation skills can be easily demonstrated through e-learning but are best supported using role play and/or feedback of recorded consultations with or without actors playing simulated patients. This is something that young doctors are very experienced in.

Changing attitudes to mental health isn’t easy but –

Listening to the experiences of those who use our services and practices is crucial, as is tackling the stigma that doctors, nurses and other professionals experience when faced with their own mental health difficulties working in an oversubscribed system.

Last but not least in this, the final blog of the series  mutual respect for working together collaboratively, and the ability to do so are absolutely key. We all have much to learn from our patients, and from each other.

This is the fifth and final post in our blog series to coincide with the release of Relias’ new mental health training courses for primary care.

To discover how our online courses and learning management system can ensure your staff are delivering the highest quality care, request a conversation with a member of our team.

Linda Gask

Linda Gask is Emerita Professor of Primary Care Psychiatry at the University of Manchester. She is a retired consultant psychiatrist and helped to set up a social enterprise that provides primary care mental health. She co-edited Primary Care Mental Health (2nd edition, Cambridge University Press) and has also written about her own experiences of depression. She can be contacted via her website


to find out more about our training and resources