Schizophrenia: community care and the family physician

Abstract

Closure of large mental hospitals has placed increasing demands on the services provided to the chronic mentally ill patients by their family physicians. Evidence from the studies carried out in the UK in the 1960s and 1970s suggested that up to one quarter of patients with schizophrenia were seen only by their family physician and contact with psychiatric services was often patchy. There are some signs that the psychiatric services have improved their input in recent times, but there remains a core group of the chronic mentally ill who will drop out of psychiatric care. Although patients with schizophrenia attend significantly more often than patients with other chronic disorders, few family physicians have specific practice policies for their care. Despite their enthusiasm about being involved in the shared care of these patients, family physicians remain reluctant to take over their day-to-day psychological care. Liaison with specialist services is in the process of continuous evolution. The use of shared care cards, similar to those widely used in the field of antenatal care, to facilitate communication between primary and secondary care professionals, has received some attention. Another important development is the expansion of liaison clinics conducted by the psychiatrists in family practice. However there remains a need for practical care protocols which can be applied and evaluated in general practice. The primary care team will not take over the care of the chronic mentally ill, rather they may provide one further important resource in a multifaceted service.