Psychiatry and Primary Care in Southern Europe


Tel Aviv University, Tel Aviv, Israel


The over-arching policy direction for mental health systems in Europe in the last decades has been deinstitutionalization: moving people out of mental hospitals towards care in the community. This change necessitated the establishment and collaboration of community mental health centers, rehabilitation facilities and primary care physicians. The role of the General Practitioner (GP) in primary care is crucial, since 24-46% of patients attend their GP due to problems related to mental health.

The reform in Italy resulted in closure of all state hospitals by 1998 and establishing comprehensive network of outpatients and residential facilities. In Israel there was a 50% reduction in psychiatric beds between 1995 and 2006. As a complementary move, rehabilitation services were developed, including hostels, supported housing and vocational services. In the third step, the direct responsibility for psychiatric services was transferred in 2015 from the state to the four national health providers. In most Southern Europe countries, GPs in primary care are already expected to diagnose, treat and manage mild to moderate mental illnesses. 71% of patients in Greece, Italy and Spain seek help for psychological and emotional problems from the GP, much more often than from psychiatrists or psychologists.

In order to enhance the GPs’ attitude, knowledge and skills, several collaborative models between psychiatrists and GPs are implemented in Southern Europe, including telemedicine in Italy and Balint groups in Portugal. There is good evidence, both, from randomized controlled trials and from descriptive studies that this collaboration may improve the primary care of patients suffering from depression, anxiety and somatization disorders.