Education And Debate

Managing common mental health disorders in primary care: conceptual models and evidence base

BMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7495.839 (Published 07 April 2005) Cite this as: BMJ 2005;330:839
  1. Peter Bower, senior research fellow (peter.bower@manchester.ac.uk)1,
  2. Simon Gilbody, senior lecturer in mental health services research2
  1. 1 National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL,
  2. 2 Department of Health Sciences, University of York, York YO10 5DD
  1. Correspondence to: P Bower
  • Accepted 31 January 2005

The use of conceptual models can help to bridge the gap between research findings and policy development, illustrated here by the complex area of primary care mental health services

Introduction

The trend is towards greater use of research evidence (especially systematic reviews) in the development of health policy. However, systematic reviews have traditionally been designed for clinical decision making, and linking such evidence to the broader perspectives and goals of policy makers is complex.1 In such cases, conceptual models are often useful. Models are abstract representations of complex areas—“inventions of the human mind to place facts, events and theories in an orderly manner.”2 We will attempt to illustrate the way in which such models can assist in the application of evidence from systematic reviews to policy, using the example of mental health care in primary care.

Models of primary care mental health

Mental health problems are an important source of burden worldwide, and a key recommendation of the World Health Organization is that treatment should be based in primary care.3 Mental health care in primary care has been defined as “the provision of basic preventive and curative mental health care at the first point of contact of entry into the health care system.”4

The structure of mental health care in primary care is generally understood in terms of the “pathways to care” model.5 Accessing mental health care involves passing through five levels and three filters between the community and specialist care (fig 1). This model highlights the importance of the primary care clinician, whose ability to detect disorder in presenting patients (filter 2) and propensity to refer (filter 3) represent key barriers to care. The model also highlights the decreasing proportion of the total population who access higher levels.

Fig 1

Pathways to care model

A wide range of mental health problems present in …

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