Patients' and health professionals' views on primary care for people with serious mental illness: focus group study
Open accessAbstract
OBJECTIVE: To explore the experience of providing and receiving primary care from the perspectives of primary care health professionals and patients with serious mental illness respectively. DESIGN: Qualitative study consisting of six patient groups, six health professional groups, and six combined focus groups. SETTING: Six primary care trusts in the West Midlands. PARTICIPANTS: Forty five patients with serious mental illness, 39 general practitioners (GPs), and eight practice nurses. RESULTS: Most health professionals felt that the care of people with serious mental illness was too specialised for primary care. However, most patients viewed primary care as the cornerstone of their health care and preferred to consult their own GP, who listened and was willing to learn, rather than be referred to a different GP with specific mental health knowledge. Swift access was important to patients, with barriers created by the effects of the illness and the noisy or crowded waiting area. Some patients described how they exaggerated symptoms ("acted up") to negotiate an urgent appointment, a strategy that was also employed by some GPs to facilitate admission to secondary care. Most participants felt that structured reviews of care had value. However, whereas health professionals perceived serious mental illness as a lifelong condition, patients emphasised the importance of optimism in treatment and hope for recovery. CONCLUSIONS: Primary care is of central importance to people with serious mental illness. The challenge for health professionals and patients is to create a system in which patients can see a health professional when they want to without needing to exaggerate their symptoms. The importance that patients attach to optimism in treatment, continuity of care, and listening skills compared with specific mental health knowledge should encourage health professionals in primary care to play a greater role in the care of patients with serious mental illness.
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General practitioners undertake a significant responsibility of diagnosing and treating a large number of patients with mental health conditions.
“General practitioners (GPs), serving as the frontline of healthcare, undertake a significant responsibility of diagnosing and treating a large number of patients with mental health conditions”
From Exploring patient experiences with a mindfulness course in a general practice setting: a qualitative study. (2025) · cites this paper as [6]
The Introduction says that people with serious mental illness frequently consult GPs and create a considerable primary-care workload. But the “Good enough” primary care section describes GPs’ agreed responsibilities chiefly as continuing prescriptions begun in secondary care, monitoring side effects, and addressing physical health; it does not establish that GPs diagnose and treat a large number of patients across mental health conditions. (LLM, conf=0.86)
Experimental — accuracy not yet measuredGPs call for additional resources and support in managing these patients, often feeling less equipped than for physical illnesses.
“GPs call for additional resources and support in managing and dedicating time to assist these patients, often feeling less equipped in comparison with their experience in treating patients with physical illnesses [6–9].”
From Exploring patient experiences with a mindfulness course in a general practice setting: a qualitative study. (2025) · cites this paper as [6]
The “Good enough” primary care section reports that most health professionals felt they lacked the skills and knowledge to provide mental health care for people with serious mental illness, while accepting responsibility for physical health care. The “Anticipating and negotiating access” section describes GPs’ efforts to obtain crisis care as stressful and time consuming. The paper does not report GPs calling for additional resources or support, and it does not directly compare their confidence with treating physical illnesses. (LLM, conf=0.84)
Experimental — accuracy not yet measured
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“Psychotic patients may not be able to recognise certain physical phenomena as a symptom of a co-morbid disease [4], and they often find it difficult to communicate their physical needs and problems and to arrange appointments for themselves [5-7].”
BackgroundMelamed, O. C., Fernando, I., Soklaridis, S., Hahn, M., LeMessurier, K. W., & Taylor, V. H. (2019) · The Canadian Journal of Psychiatry · doi:10.1177/0706743719862980 · Cited by 42 · see citing works
“Consistent with previous reports, certain environments such as noisy and crowded waiting rooms are a deterrent to some participants.(30) Most participants struggled to adjust to a multidisciplinary medical program, specifically as they had limited knowledge and prior experience with this type of health-care delivery m…”
ResultMesidor, M. M., Gidugu, V., Rogers, E. S., Kash-MacDonald, V. M., & Boardman, J. B. (2011) · Psychiatric Rehabilitation Journal · doi:10.2975/34.4.2011.285.294 · Cited by 41 · see citing works
Beliefs of people taking antidepressants about the causes of their own depression
Read, J., Cartwright, C., Gibson, K., Shiels, C., & Magliano, L. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.11.009 · Cited by 37 · see citing works
“…that these sorts of life events have made you feel depressed might hinder the development of a therapeutic relationship, especially, perhaps, if the doctor has a strong bio-medical framework for depression, as is often – but not always – the case (Lester et al., 2005; Schumann et al., 2012).”
BackgroundKey stakeholders’ perspectives towards childhood obesity treatment: A qualitative study
Staniford, L. J., Breckon, J. D., Copeland, R. J., & Hutchison, A. (2011) · Journal of Child Health Care · doi:10.1177/1367493511404722 · Cited by 39 · see citing works
“nurses, doctors and therapists) and treatment recipients’ views towards treatment (Lester, 2005; Pellatt, 2007; Pryor and O’Connell, 2008).”
BackgroundDew, K. P., Morgan, S. J., Dowell, A. C., McLeod, D. L., Bushnell, J., & Collings, S. C. (2007) · Sociology of Health & Illness · doi:10.1111/j.1467-9566.2007.01022.x · Cited by 39 · see citing works
A Handbook for the Study of Mental Health
(2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289 · Cited by 38 · see citing works
Horwitz, A. V. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.004 · Cited by 38 · see citing works
Primary Care After Psychiatric Crisis: A Qualitative Analysis
Griswold, K. S., Zayas, L. E., Pastore, P. A., Smith, S. J., Wagner, C., & Servoss, T. J. (2008) · The Annals of Family Medicine · doi:10.1370/afm.760 · Cited by 37 · see citing works
How do General Practitioners experience providing care for their psychotic patients?
Oud, M., Schuling, J., Slooff, C. J., & Jong, B. M. (2007) · BMC Family Practice · doi:10.1186/1471-2296-8-37 · Cited by 37 · see citing works
Comorbidity of mental and physical disorders
(2014) · Key Issues in Mental Health · doi:10.1159/isbn.978-3-318-02604-7 · Cited by 37 · see citing works
Safely cared for or empowered in mental health care? Yes, please
Rise, M. B., Westerlund, H., Bjørgen, D., & Steinsbekk, A. (2013) · International Journal of Social Psychiatry · doi:10.1177/0020764012471278 · Cited by 36 · see citing works
“It has also been shown that changing professionals and having to explain problems several times is straining (Crawford et al., 2004; Lester et al., 2005).”
BackgroundUsing interview excerpts to facilitate focus group discussion
Geampana, A., & Perrotta, M. (2024) · Qualitative Research · doi:10.1177/14687941241234283 · Cited by 55 · see citing works
“The focus group method has been instrumental in understanding challenging areas of medical practice (Barbour, 2005, 2018; Lester et al., 2005).”
Shim, R. S., Druss, B. G., Zhang, S., Kim, G., Oderinde, A., Shoyinka, S. O., & Rust, G. S. (2014) · Schizophrenia Research · doi:10.1016/j.schres.2013.12.002 · Cited by 34 · see citing works
“Even so, some primary care providers report difficulty communicating effectively and providing effective care for individuals with serious mental illness (Lester et al., 2005).”
BackgroundVariables associated with general practitioners taking on serious mental disorder patients
Fleury, M., Bamvita, J., & Tremblay, J. (2009) · BMC Family Practice · doi:10.1186/1471-2296-10-41 · Cited by 34 · see citing works
“Although current reforms encourage GPs to manage more SMD patients, few studies have been published as yet on this subject [19,31,32].”
BackgroundBaker, E., Gwernan‐Jones, R., Britten, N., Cox, M., McCabe, C., Retzer, A., Gill, L., Plappert, H., Reilly, S., Pinfold, V., et al. (2019) · BMC Psychiatry · doi:10.1186/s12888-018-1997-z · Cited by 33 · see citing works
“Primary care practitioners also often lack the necessary time and training to effectively support people with these diagnoses in addressing their mental health needs [4 – 6].”
BackgroundTritter, J. Q., & Landstad, B. J. (2019) · Wiley eBooks · doi:10.1002/9781119410867.ch5 · Cited by 33 · see citing works
Self-citationKim, W., Jang, S., Chun, S., Lee, T.-H., Han, K., & Park, E. (2017) · Journal of Korean Medical Science · doi:10.3346/jkms.2017.32.5.835 · Cited by 32 · see citing works
“Non-psychiatrist providers may also lack experience in treating mental illnesses, which requires the need for adequate cooperation between non-psychiatrists and psychiatrists (25).”
BackgroundCook, J. Α., Razzano, L. A., Swarbrick, M. A., Jonikas, J. A., Yost, C., Burke, L., Steigman, P. J., & Santos, A. B. (2015) · PLoS ONE · doi:10.1371/journal.pone.0123552 · Cited by 30 · see citing works
Cunningham, R., Imlach, F., Haitana, T., Every‐Palmer, S., Lacey, C. J., Lockett, H., & Peterson, D. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1285431 · Cited by 29 · see citing works
“(W, 26–35) Poor treatment of the”
Sinding, C., Watt, L., Miller, P., Silliker, J., Lawson, L., Kislinsky, C., Stanzlik-Elliot, C. L., O'Neill, J., Pereira, J., & McGillicuddy, P. (2013) · Social Work in Mental Health · doi:10.1080/15332985.2012.758075 · Cited by 29 · see citing works
“This is a finding consistent with many other studies (Viron & Stern, 2010), including studies in which patients were interviewed (Lester et al., 2005; Leutwyler & Wallhagen, 2010).”
BackgroundResultRuud, T., Aarre, T. F., Boeskov, B., Husvåg, P. S., Klepp, R., Kristiansen, S. A., & Sandvik, J. (2016) · International Journal of Mental Health Systems · doi:10.1186/s13033-016-0064-8 · Cited by 28 · see citing works
“According to patients and health professionals, GPs are important for patients with SMI [5].”
BackgroundO’Loughlin, E., Hourihan, S. J., Chataway, J., Playford, E. D., & Riazi, A. (2016) · Disability and Rehabilitation · doi:10.1080/09638288.2016.1211760 · Cited by 28 · see citing works
“A growing body of qualitative literature in healthcare has explored the perspectives of HPs in combination with those of patients in examining the issues faced by patients and healthcare services [19, 20, 21, 22, 23].”
BackgroundStumbo, S. P., Yarborough, B. J. H., Yarborough, M. T., & Green, C. (2018) · American Journal of Health Promotion · doi:10.1177/0890117118763233 · Cited by 26 · see citing works
“Quality preventive care delivery begins with the relationship between primary care providers (PCPs) and patients,(14-16) and this may be especially true for individuals with serious mental illnesses who see the relationship with their PCP as critical to their health.(17) The current analyses were part of a larger mixe…”
Cerimele, J. M., Fortney, J. C., Pyne, J. M., & Curran, G. M. (2018) · Family Practice · doi:10.1093/fampra/cmy019 · Cited by 27 · see citing works
“A prior study found that primary care patients with serious mental illness including bipolar disorder reported expecting ‘good enough’ primary care including treatment with psychotropic medication and a consistent relationship with a primary care clinician who could access psychiatrists for advice as needed (30).”
BackgroundImproving the physical health of people with severe mental illness
Silverwood, V., Chew-Graham, C. A., & Shiers, D. (2019) · InnovAiT Education and inspiration for general practice · doi:10.1177/1755738018823800 · Cited by 26 · see citing works
“Reporting a focus group study, Professor Lester describes how people with SMI regard primary care as the cornerstone of their physical and mental health care, valuing the continuity and holistic approach (Lester et al., 2005) reflected by their annual consultation rates of about 13 per year.”
BackgroundNash, M. (2014) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12140 · Cited by 26 · see citing works
“Research suggests that health-care professionals find difficulty diagnosing physical complaints once a mental health disorder had been diagnosed (Lester et al. 2005).”
BackgroundBrowne, J., Mihas, P., & Penn, D. L. (2015) · Community Mental Health Journal · doi:10.1007/s10597-015-9896-y · Cited by 26 · see citing works
“Focus groups have been successfully utilized in research involving individuals with SMI and mental health providers (Aschbrenner et al. 2013; Happell et al. 2012; Lester et al. 2005; Mason and Holt 2012; McDevitt et al. 2006; McKibbin et al. 2014).”
MethodThe global mental health assessment tool-validation in hindi: A validity and feasibility study
Sharma, V. K., Jagawat, S., Midha, A., Jain, A., Tambi, A., Mangwani, L., Sharma, B., Dubey, P., Satija, V., Copeland, J. R. M., et al. (2010) · Indian Journal of Psychiatry · doi:10.4103/0019-5545.74305 · Cited by 26 · see citing works
“[1] A vast majority of people with mental disorders including with severe mental illness view primary care as the cornerstone of their health care system.[2] It takes about six years to train a doctor and a further 6 years to train as a psychiatrist.”
BackgroundMaragakis, A., Siddharthan, R. V., RachBeisel, J. A., & Snipes, C. (2015) · Primary Health Care Research & Development · doi:10.1017/s1463423615000523 · Cited by 25 · see citing works
Serious Mental Illness and the Role of Primary Care
Planner, C., Gask, L. L., & Reilly, S. (2014) · Current Psychiatry Reports · doi:10.1007/s11920-014-0458-8 · Cited by 25 · see citing works
Use of GP services by patients with schizophrenia: a national cross-sectional register-based study
Hetlevik, Ø., Solheim, M. H., & Gjesdal, S. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-0719-1 · Cited by 24 · see citing works
“A good relationship with a GP and stable cooperation with the local healthcare services can improve social participation and quality of life, and increase survival among patients [2,22,24,26].”
BackgroundBirchwood, M. J., PETERS, E. R., Tarrier, N., Dunn, G., Lewis, S. W., Wykes, T., Davies, L. M., Lester, H. E., & Michail, M. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-155 · Cited by 25 · see citing works
Self-citationSharma, V. K., Lepping, P., Krishna, M., Durrani, S., Copeland, J. R. M., Mottram, P. G., Parhee, R., Quinn, B. N. E., Lane, S., & Cummins, A. (2008) · British Journal of General Practice · doi:10.3399/bjgp08x299218 · Cited by 25 · see citing works
“A vast majority of people with mental disorders, including those with severe mental illness, view primary care as the cornerstone of their healthcare system.(2) In the modern NHS, GPs and other primary care workers are expected to identify and assess the mental health needs of their patients, and to manage common ABST…”
BackgroundEarly intervention in psychosis: keeping the body in mind
Shiers, D., Jones, P. B., & Field, S. (2009) · British Journal of General Practice · doi:10.3399/bjgp09x420888 · Cited by 24 · see citing works
“GPs are often more comfortable discussing physical than mental health issues with patients with psychosis, seeing that as their core role.(24) Primary care and specialist mental health clinicians could work together to provide clear and consistent information to help patients understand and weigh the benefits and risk…”
BackgroundSilverman, M. J. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01569 · Cited by 24 · see citing works
“In a qualitative investigation, outpatients with serious mental illnesses emphasized the importance of hope for recovery as well as practitioner optimism in treatment (Lester et al., 2005).”
BackgroundExploring the value of mental health nurses working in primary care in England: A qualitative study
McLeod, K., & Simpson, A. (2017) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12400 · Cited by 24 · see citing works
Reforming the Portuguese mental health system: an incentive-based approach
Perelman, J., Chaves, P., Caldas‐de‐Almeida, J. M., & Matias, M. A. (2018) · International Journal of Mental Health Systems · doi:10.1186/s13033-018-0204-4 · Cited by 24 · see citing works
“For example, a focus group with general practitioners (GPs), conducted in the UK, observed that “serious mental illness (is) too specialized for routine primary care and felt they lacked sufficient skills and knowledge” [8].”
BackgroundStudying Stress in the Twenty-First-Century: An Update of Stress Concepts and Research
Wheaton, B., & Montazer, S. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.013 · Cited by 24 · see citing works
- Authors
- Lester, H., Tritter, J. Q., & Sorohan, H.
- Affiliations
- University of Birmingham (GB)
- University of Warwick (GB)
- University College Birmingham (GB)
- ORCID
- Tritter, Jonathan Q
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2005-04-20
- Volume
- 330
- Issue
- 7500
- Pages
- 1122
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC557894
- OpenAlex
- W1822286663
- Cited by
- 339
- References
- 29
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 6 · 2023: 11 · 2022: 5 · 2021: 18 · 2020: 11 · 2019: 15 · 2018: 28 · 2017: 52 · 2016: 13 · 2015: 20 · 2014: 21 · 2013: 15 · 2012: 32
- FWCI
- 12.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- severe mental illness, primary care, patient perspectives, health professional perspectives, general practitioners, practice nurses, health care access, waiting time, symptom exaggeration, secondary care referral, continuity of care, listening skills
- MeSH terms
- Adolescent, Adult, Aged, Attitude of Health Personnel, Attitude to Health, Mental Disorders, Chronic Disease, Female, Health Services Accessibility, Humans, Male, Middle Aged, Nurse Practitioners, Physicians, Family, Primary Health Care, Focus Groups
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