ABSTRACT

Many psychiatric illness surveys in the UK, in particular, have been based either on individual practice lists or on area Family Practitioner Committee lists, and prevalence estimates computed by using these as the population denominator. Rates of referral to psychiatric out-patient services are usually found to decline in the higher age-groups, a trend unrelated to the age-specific prevalence of mental disorder. A. F. Henderson has proposed as one outstanding priority in social psychiatry ‘studies of the contribution of general practice to the care of mental disorders of the elderly, and how to improve that contribution’. In thus correctly emphasizing the importance of treatment and management in primary health care, he may also have pointed to the most promising direction of advance for the new discipline of psychogeriatric epidemiology. Since the 1960s a number of alternatives to hospital referral have been reported, in which psychiatrists undertake regular sessions in general practice and work closely with the primary-care team.