ABSTRACT
An historical perspective helps us to establish the changing relationships between primary medical care and community psychiatry. A WHO Working Group report in 1973 stated that ‘the primary medical care team is the cornerstone of community psychiatry’. The influence of Michael Shepherd’s seminal work on this conclusion is clear. Some sixteen years later another WHO Working Group reported that ‘the further development of a comprehensive community-based network of mental health and psychiatric services in Member States was considered to be an indispensable precondition for the overall improvement of mental health care in primary health care settings’ (WHO, 1990). The change in the perspective can be summarised as follows: from the view that primary care is a necessary and essential ingredient for community psychiatry, to the view that an improved community psychiatric service is necessary to provide better mental health care in general practice. The influence of David Goldberg upon this latter conclusion is equally clear. In addition, he was instrumental in building upon the insights of Michael Shepherd by broadening the field of research from conspicuous morbidity (which was the subject of the noted monograph by Michael Shepherd et al. 1966), to a consideration of total morbidity. As a consequence, a new conceptualisation became possible, which included both patients not correctly identified by family doctors as mentally ill (false negatives), and those who are wrongly identified by their GPs (false positives).
