Filling the chasm

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Reimagining primary mental health care

Dr Karen Newbigging, Dr Graham Durcan, Dr Rebecca Ince and Andy Bell
10 December 2018

Primary care services provide the vast majority of NHS mental health support, yet their role has been ignored in successive national policies and strategies. Filling the chasm by Centre for Mental Health and University of Birmingham explores a number of local initiatives which are bridging the gap between primary care and secondary care services, supporting people who fall into this ‘grey area’ due to having more complex needs, not meeting secondary care thresholds, or presenting with multiple or medically unexplained symptoms.

The report describes promising approaches in eight local areas: Bradford, Cambridge and Peterborough, Catterick, Cornwall, Norfolk and Suffolk, Northamptonshire, Swindon and Tower Hamlets.

Having studied and learned from these approaches, we’ve identified some key elements for future primary care developments:

  • Identifying the opportunities for prevention and promotion of mental health – including in the perinatal period; with children and young people; and through providing information and resources
  • Maximising social interventions for mental health – moving away from anti-depressants and therapy as the only solutions, improving awareness of community resources
  • Culture change – embracing the holistic approach – valuing social support and linking to physical health initiatives
  • Empowering the person – moving ‘from patient to person’ – enabling people to make their own decisions about what they need to focus on, addressing social factors and causes of mental health problems
  • Bridging the gap between primary and secondary care – co-locating services, employing senior staff to provide consultancy and supervision
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