Liaison psychiatry in general practice.

In the WHO (1973) working group report on psychiatry and primary medical care, six reasons why the GP must remain the first-contact physician for psychiatric morbidity are outlined: 1. Mentally disturbed patients often present with physical complaints 2. Physical illness and psychiatric disorder do coexist 3. There is still a major stigma associated with institutionalized psychiatric care 4. There is a danger that otherwise patients may unwisely gravitate from one specialist to another 5. Many psychiatric problems are connected with social factors and conflicts of family life 6. The GP is in the best position to maintain contact with most of his patients over the years. Liaison psychiatry in general practice allows the consultant psychiatrist and psychiatric trainees a unique opportunity to assist the GP in this work. However, for the liaison to succeed the GP must take the risk of sharing some of his hard won and jealously guarded autonomy with the specialist, and the specialist, in turn, must be prepared to commit scarce time to this enterprise and take the risk of exposing himself personally to colleagues who can have a different perspective and professional philosophy from his own.