To disclose or not to disclose psychological problems to GPs.

To disclose or not to disclose psychological problems to GPs Non-detection of common mental disorders in primary care is often interpreted as a reflection of GPs' knowledge and skills. A common approach to dealing with non-detection of mental disorders in primary care is to provide further psychiatric training to improve the rate and accuracy of recognition of mental health disorders. However, the findings from two recent studies on this topic indicate that this strategy is insufficient to ensure young people's psychological problems are not missed. In this issue, the study by Mauerhofer et al 1 on help-seeking patterns of young people shows that they are more likely to seek help for psychological problems from an informal source, such as an educational professional, than from a formal healthcare source. They also found that most of the young people who did not seek help for psychological problems had attended primary care at least once during the previous year. The study by Haller et al in the March issue of the BJGP highlights the multifaceted problem of identifying mental health disorders in young people. 2 Their results indicated that non-detection of depression and anxiety symptoms in young primary care patients, aged 16–24 years, is associated with a young person's mental health literacy, health-related fears, frequency of consultations, and continuity of care. GP level of training in mental health or adolescent health care was not associated with identification of mental disorder. The results of both studies challenge the superficial appeal of GP psychiatric training as the sole strategy for improving recognition of mental health problems in primary care. Taken at face value, results suggest that any improvement requires a focus on both patient and relationship factors, and a need to be more careful when concluding that undetected mental disorder in primary care indicates poor quality of care. The studies by Mauerhofer et al 1 and Haller et al 2 remind us that there are alternative ways of examining this topic that can be applied, for example, when planning studies or developing practice guidelines to improve the quality of health care provided to young people. Understanding barriers to identifying young people in need of mental health support is a clinical and research priority for primary care. This is because we know little about the barriers and facilitators to detecting mental ill health among this patient group. The implications of undetected and untreated mental health problems …