Managing crisis: the role of primary care for people with serious mental illness.
OBJECTIVE
More than 30% of patients with serious mental illness in the United Kingdom now receive all their health care solely from primary care. This study explored the process of managing acute mental health crises from the dual perspective of patients and primary care health professionals.


METHODS
Eighteen focus groups involving 45 patients, 39 general practitioners, and eight practice nurses were held between May and November 2002 in six Primary Care Trusts across the British West Midlands. The topic guide explored perceptions of gold standard care, current issues and critical incidents in receiving/providing care, and ideas on improving services.


RESULTS
Themes relevant to the management of acute crisis included issues of process, such as access, advocacy, communication, continuity, and coordination of care; the development of more structured care that might reduce the need for crisis responses; and issues raised by the development of a more structured approach to care.


CONCLUSIONS
Access to services is a complicated yet crucial feature of managing care in a crisis, with patients identifying barriers at the level of primary care and health professionals at the interface with secondary care. The development of more structured systems as a solution may generate its own ethical and pragmatic challenges.
Lester
Helen
H
Department of Primary Care and General Practice, University of Birmingham, Birmingham, England. H.E.Lester@bham.ac.uk
Tritter
Jonathan Q
JQ
Sorohan
Helen
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D003419:Crisis Intervention; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D020380:Needs Assessment; D010348:Patient Care Team; D011320:Primary Health Care / Q000592:standards*; D012017:Referral and Consultation; D006113:United Kingdom