ABSTRACT
Over 25 years ago, Goldberg and colleagues first described the high prevalence of common mental disorders among patients presenting to general practitioners (Goldberg and Blackwell, 1970). A subsequent quarter-century of research has led to dramatic shifts in our understanding of mental disorders and mental health services. We now understand that patients presenting to psychiatric hospitals or speciality clinics represent only the conspicuous tip of the iceberg of psychiatric morbidity (Regier et al. 1978; Regier et al. 1993; Goldberg et al. 1976). Over the last decade, new models of mental health care have been developed to address the major portion of psychiatric morbidity which never appears in the speciality clinic. These new treatment models have led to a fundamental redefinition of the role of the psychiatrist in the management of psychiatric morbidity. This review will describe recent research which has contributed to the development of these new models of treatment and will discuss the implications of this research for the roles of psychiatrist.
