Improving the Recognition and Management of Common Mental Disorders in Government-Operated Primary Care Settings in Penang, Malaysia: Feasibility of a Pilot Primary Care Consultation-Liaison Psychiatry Service and Impact on Undergraduate Medical Education

International evidence suggests that the implementation of evidence-based interventions for common mental disorders (CMDs) in primary care settings is challenging, especially in low and middle-income countries. This thesis is based on a clinical and medical educational research initiative carried out by the author at Penang Medical College, Malaysia in collaboration with local academic colleagues and clinicians and support from academics in his home institution in RCSI, Dublin. The aims of the study were to explore challenges and opportunities in delivering enhanced care for CMDs in Malaysian government-operated primary care clinics and the potential added educational value of medical students learning psychiatry in primary care settings. Mixed qualitative and quantitative methods and a process evaluation framework were employed to evaluate current primary care services for CMDs and the operation and utilisation of an on-site pilot consultation-liaison psychiatry service at two primary care clinics in Penang. Semi-structured individual interviews with front-line clinicians and focus groups with medical students explored perceptions of CMDs and the experience of participation in the pilot intervention. The study found that barriers to the recognition and management of CMDs arose from weak structures and processes to support current primary care mental health policy implementation. Other challenges include competing service demands on frontline clinicians and limitations in clinicians’ understanding of the benefits of recognition and management of CMDs. The pilot consultation-liaison intervention, however, was broadly implemented and utilised as intended and participating front-line clinicians appeared to value holistic care and reported a change in their understanding of CMDs. Medical students rated their primary care experiences as providing considerable added value in comparison with other clinical placements in questionnaire survey responses and in focus group thematic findings. These results highlight the need for and potential benefits from investment in front-line clinician support from family medicine and mental health specialists in the future implementation of evidence-based programmes for CMDs in Malaysian primary care settings. In addition, the study suggests that primary care experiences should be considered as a regular component of the clinical clerkship in psychiatry for medical undergraduates.