Attitudes of general practitioners and community mental health team staff towards the locus of care for people with chronic psychotic disorders

Shared care of the long-term mentally ill (LTMI) has long been advocated but little is known about the attitudes of general practitioners (GPs) and mental health workers (MHWs) towards the locus of care of these patients. In order to compare MHWs' and GPs' attitudes towards the care of patients with chronic psychosis, in 1998 52 GPs and 58 MHWs involved in a study which was conducted in three London boroughs about the locus of care for people with chronic psychotic disorders were asked to complete postal questionnaires. These questionnaires examined the issues of responsibility for both mental and physical care, difficulties in providing care and professional satisfaction. There was agreement that psychiatric teams should take overall responsibility for these patients, although in most cases 'care should be shared'. The results showed that the MHWs wanted GPs to take more responsibility for physical treatment than the GPs themselves wanted, that the GPs had mixed feelings about relapse monitoring and that the MHWs found patients with chronic psychosis more rewarding and less difficult to work with. A comparison with a 1991 study of GPs showed little change. However, despite recent adverse publicity, a higher proportion of the GPs in 1998 agreed that these patients are better off in the community, The GPs and MHWs generally agreed on the roles they should take in the management of patients with chronic psychosis but some important differences remai