Introduction

Tidy-minded health service planners often suggest a division of labour between primary and secondary care where ‘neurotic’ disorders are managed by general practitioners and ‘psychotic’ ones are handed over to the specialist mental health team. This attractive bureaucratic solution is, as any experienced general practitioner will know, no match for the real world. Many ‘neurotic’ disorders are far from simple and may require the full resources of a specialist mental health service. The contribution of general practitioners to the care of individuals with psychotic illnesses living in the community was clearly demonstrated in Murray-Parkes, Brown & Monck's (1962) survey of schizophrenic patients in London. Twelve months after discharge, only 56% were still in contact with a psychiatrist, while 70% had had recent contact with their general practitioner. Despite the increasing emphasis on community care and the expansion of mental health teams over the last 30 years the situation is virtually unchanged today. Twelve months after discharge from a West Lambeth mental hospital only 52% of patients with schizophrenia were found to be still in contact with a psychiatrist, while 57% were in contact with their general practitioner (Melzer et al., 1991). Only 60% of patients with chronic schizophrenia identified in setting up a case register in Camden had any continuing contact with specialist services (Pantelis, Taylor & Campbell, 1988).