The role of psychiatry in primary care: WPA Section contributions

The WPA Section on Psychiatry, Medicine and Primary Care was established to foster collaboration between psychiatry and primary care, focusing on pertinent topics in health care. Here we summarize and highlight the strides made in this crucial collaboration. In addition, we present recent activities of the Section. In the past decades, there has been significant progress in integrating psychiatry and behavioral health care into primary care settings. Given the growing recognition of the pivotal role of mental health in physical health, quality of life, and overall well-being, as well as the global shortage of psychiatrists and trained mental health professionals, particularly in low- and middle-income countries (LMICs) and rural areas, this integration has become a global public health and policy priority. Some key developments in this area include the following. Collaborative care models involve a team-based approach, in which primary care providers work closely with psychiatric/behavioral health consultants to deliver coordinated and comprehensive community-based care for patients with mental health conditions. This approach has been found to be effective in improving patient outcomes and satisfaction, while enhancing the health care workforce's capacity to identify mental health conditions and provide support to those in need of mental health services1. Primary care providers are increasingly using validated screening tools to identify patients at risk of mental disorders, and user-friendly screenings for mental health challenges are becoming an integral part of primary care delivery2. This facilitates early detection and timely intervention, leading to better outcomes for patients. The cost-effectiveness of identifying at-risk and early-onset individuals is well established, as is the case with cancer, cardiac and diabetic screening programs worldwide. Efforts have been made toward enhancing primary care providers’ psychiatric knowledge and skills through training programs and continuing education activities. This enables primary care providers to better recognize, diagnose and manage mental health conditions in their patients. This training can also address mental health promotion and maintenance of optimal mental and physical health through lifestyle psychiatry interventions in primary care settings. With advances in technology, digital services are becoming more widely available and used in primary care settings. This allows patients to receive mental health care support remotely, improving access for those in underserved areas, such as LMICs and rural areas, and patients with limited mobility. These developments also help better connect primary care providers with mental health specialists, ensuring continuity of care3. The relationship of lifestyle interventions with prevention and treatment for mental health is well researched4. In line with the WPA Action Plan 2023-20265-9, the focus on these interventions is now gaining traction. Primary health care practitioners are often the first contact point for the population and are already experts in lifestyle interventions. That should now include lifestyle interventions for mental health. Overall, the integration of psychiatry into primary care is crucial in addressing the mental health needs of the global population and improving health outcomes. By working together, primary care providers and psychiatrists can provide more holistic and patient-centered care for individuals with symptomatic and syndromal mental health conditions, as well as collaborate in preventive and mental health promotion efforts. As the Section on Psychiatry, Medicine and Primary Care has grown over the past few years, the number of its ongoing scholarly projects has expanded. Members of the Section collaborated in the development of a US National Institute of Mental Health (NIMH) grant addressing a novel approach to community-based mental health care in rural Malaysia. This grant focuses on a collaborative model of care, screening and assessment, and training and education of local community providers, including schools and community leaders outside the medical profession. In addition, the project utilizes cell phone-based applications developed in the region by the local University. Section members and leadership have delivered numerous contributions at recent WPA meetings, including the World Congress of Psychiatry in Vienna in 2023, and the WPA Thematic Conference held in Malta in 2022. Topics have included the role of lifestyle psychiatry in primary care; mental health care of refugees and victims of trauma and abuse; depression, anxiety and substance abuse in primary care; and digital psychiatry. During the above-mentioned World Congress, the Section leadership met with the President of the World Organization of Family Doctors (WONCA) to discuss future collaborations and the role of telemental health in primary care. A major focus of the Section has been on training the next generation of psychiatrists in the importance of inter-professional collaboration, and engaging and empowering them during their training. Educational activities run by the Section started with the support and collaboration of the Association for Community Mental Health Promotion (ACMHP). Out of this collaboration, the SEED (Students' Education, Empowerment and Development in Mental Health) group was established. This group, headed by the Section officers, holds a monthly YouTube session for medical students and early career psychiatrists from around the world. To date, 30 videos have been produced with contributions from experts and global leaders within WPA, and a manuscript is currently in press. Given the expanding number of projects, the Section has created workgroups in various areas of interest to its members. It is also working in collaboration with other WPA Sections on topics of common interest, such as the role of exercise in mental health with the Section on Exercise and Sports Psychiatry. The current Section officers are committed to continuing to contribute to the growth and development of the field. As a first step, and in order to ensure that this process continues to build on previous achievements, the Section has formed a consulting group composed of previous Section chairs and highly experienced WPA leaders, and has developed the Section's action plan 2023-2026. We would like to take this opportunity to invite WPA members to join and contribute to our Section.