Sub-threshold mental health syndromes: finding an alternative to the medication of unhappiness.

Sub-threshold anxiety and depression are common presentations in primary care. They carry a significant disability burden along with the risk of developing a frank disorder. Intervention options are limited, although there is some evidence that ultra brief interventions may be effective with this patient group. We argue that there is a need for a systematic but ultra brief, minimal contact intervention, that can be delivered by GPs or practice nurses. Such an intervention would be a form of facilitated self-management, a step up from self-help, from which people could be referred on to more intensive treatment or medication if required.