ABSTRACT
During the early 1990s, community mental health nurses based in Wirral decided to actively negotiate with General Practice fundholders in order to raise their own profile and aim for greater professional independence, rather than accept the more traditional ways of working, e.g. accepting consultant only referrals. The initial drive or idea of creating a mental health register stemmed from a number of thoughts. The group was recognised as suffering social isolation and poor physical health, and lacking the social confidence to ask for assistance. The emphasis was placed on identifying and registering the vulnerable individuals with a diagnosis of psychosis, chronic depression, and more recently dementia. A more pragmatic approach might be to support thriving initiatives in primary care which demonstrate improved health outcomes, for otherwise the less attractive areas of health care may end up suffering most. Mental health is no exception to this formula, and is often seen by general practitioners as a problem of under-funding.
