Mental health services--primary concerns for the future.

399 LETTERS Mental health services — primary concerns for the future Sir, As primary care groups (PCGs) take over commissioning the majority of mental health services, they may seek to shift the emphasis of commissioned care to meeting the needs of patients suffering from mild and moderate degrees of mental illnesses, such as anxiety and mild depression, at the expense of those with severe, enduring mental illnesses. We should like to sound a note of caution to PCGs as they assume increasing responsibility for commissioning mental health care services. There is a general feeling in primary care that there has been little effective help in the past for primary health care teams who have struggled to cope with complex patients; 1 often those with inadequate or psychopathic personalities, chronic neuroses , schizophrenia, manic depressive psy-choses, or patients with 'dual' diagnoses. A shift in the focus of services towards primary care would conflict with guidance from the centre to prioritize the needs of the severe and enduring mentally ill and emphasize public safety, above all else. As PCG commissioning of mental health care services begins, GPs may favour diverting resources to patients with mild to moderate mental illnesses, and the balance in the range and extent of provision could slip too far towards the primary care setting. Over-medicalizing people whose main problem is that they simply cannot cope with life, and for whom it is convenient to categorize as having a mild mental illness instead of a social problem, would be a costly mistake. Effective commissioning will require a secure evidence base, which does not yet exist. As with so many other aspects of mental health care, there has been a relative neglect of research and development. 2 Many mental health interventions remain untested. Mental health is to be a priority for the National Service Frameworks, 3 and the construction of national standards and performance measures should provide an opportunity for commissioning effective mental health care and be a stimulus for more research where insufficient evidence is found. The Royal College of General Practitioners is leading the way in educating GPs in mental illnesses by developing a new network of over 60 teachers around Great Britain, who are doing bottom-up, practice-based, learner-friendly multipro-fessional skills training. But primary care professionals will not be motivated to take up such training and improve their recognition rates of mental illness unless there are sufficient resources …