LETTERS

David Gowdy's vitriolic counterblast (letters, page 23, 8 February) to our article ('Eye off the ball', page 25 January) together with Stephen Nickless (8 February) and Alan and Elaine Cohen's letters (15 February) amply demonstrate the truth of our original case.

Rather than a priority, mental health appears as a primary care irritant.

Mr Gowdy allowed his irritation at others in his organisation to obscure his view. Training was not the issue. It was a desire to engage in the new mental healthcare agenda that was absent.

PHASE does not train GPs, is not a computer-based 'untried electronic system' and does not require GPs to fill in questionnaires.

It is a low-tech, patientcentred, paper-based solution to treating the 90 per cent of mental health patients for whom GPs do not have a secondary care alternative.

We disagree with Stephen Nickless that GPs and their staff treat mental health problems 'remarkably well', and are surprised that Cohen and Cohen consider these patients to be 'successfully managed'. Ample published evidence demonstrates that doctors and nurses in primary care feel inadequately equipped to deal with common mental health problems and that their management of these patients is far from universally optimum.

We are grateful to the letter writers for revealing the financial imperative more clearly than we dared. These are at the heart of primary care mental health apathy. We fear that the ambitious reform agenda will be shipwrecked on the reefs of such sentiments. Unless the new contract removes the incentive from quantity and rewards quality, access and equity, primary care will continue to turn its back on mental health as an uneconomic burden.

Sadly, Lisa Smith's letter of support (15 February) is the only one securely patient and carer-focused. It is not our 'arrogance', but that of Cohen and Cohen, that has to be challenged lest more people with a legitimate interest in primary mental healthcare suffer the same frustrating indignities as Smith.

Like Gowdy and Nickless, we are clinicians (two nurses and a clinical psychologist), part of a multidisciplinary team (including a GP) committed to improving service delivery and organisation of care to one of society's most disadvantaged groups. We are grateful to Gowdy for reminding readers that we are indeed wage slaves, unencumbered by perverse financial incentives and able to disentangle our moral interests from our personal economic ones.

Ann Richards Project manager David Richards Senior lecturer Michael Barkham Professor of clinical and counselling psychology Manchester University