5. Psychiatric morbidity in general practice

It is well known that the great majority of patients presenting psychiatric symptoms are treated by GPs rather than by specialist psychiatric personnel (Shepherd et al. 1966). Goldberg & Huxley (1980) have proposed a model to describe psychiatric disorders and their care, consisting of five levels and four filters. Level 1 refers to psychiatric and emotional disorders in the community as a whole, and filter 1 represents the decision to, and act of, consulting a GP. Level 2 consists of all psychiatric morbidity that presents to GPs, although a proportion is not recognized as such (the hidden psychiatric morbidity – HPM). Filter 2 is thus the process of identification, and level 3 refers to the morbidity so identified (the conspicuous psychiatric morbidity – CPM). Filter 3 is the process of referral to the specialist psychiatric services, the patients of which are designated as level 4. A proportion of patients at this level will be admitted to hospital (i.e. will pass through filter 4) and reach level 5 (psychiatric in-patients).