[Mental health in primary care: applying psychiatric knowledge to primary care or a whole different practice?]

BACKGROUND: In Canada and several other countries, large cohorts of patients who used to be followed in psychiatric clinics are now steered toward primary care. To support this new reality, measures have been taken and investments made in service organization, collaborative work arrangements, and teaching geared toward primary care clinicians. However, these initiatives were implemented when little was known about GPs' needs.

METHODS: Using a qualitative approach, we analyzed the content of GPs' statements to explore when, why, and for what concerns GPs are inclined to collaborate with or seek advice from psychiatrists.

RESULTS: The results provide an innovative understanding of their practice and its boundaries and suggest that the management of patients with mental health problems in primary care is actually very different from what is done in psychiatry.

CONCLUSION: Uncertainty about the broad spectrum of what is normal, the longitudinal aspect of the relationship, and the proximity of the soma are among the specificities we found that could be helpful in organizing care and educating primary care clinicians and medical students more coherently and efficiently.