Letters

Congratulations on publishing Elizabeth Armstrong's vital 'wake-up call' to commissioners across the UK for some systematic training about mental health in primary care services ('Of primary importance', training and development special report, pages 13-14, 24 February).

Without high-quality training of the sort described, the ambitions of Saving Lives: our healthier nation will fail. However, one should not confuse 'primary care' with 'what goes on in the GP surgery'. For example, early intervention in mental disorders such as substance misuse, deliberate self-harm or eating disorders, and mental health promotion for vulnerable groups ('Waterhouse watershed', news focus, pages 13-15, 24 February), need to reach the school-age population.

We need to value school nurses as a mental health resource and recognise the contribution of nonNHS professionals working in the educational psychology service and social services. Educational initiatives might even involve teachers and school governors. Pat Jackson and colleagues at the Community Practitioners & Health Visitors Association have already begun work on a national service framework for school healthcare, and would welcome the views of other professions and young patients.

Joined-up services for this age group have also been considered recently by the Mental Health Foundation and the social services inspectorate. GPs have very little contact with 'socially excluded' groups like homeless people or those with learning disabilities, yet they may be especially vulnerable to developing mental illness.

As Elizabeth Armstrong says, we need to develop educational materials and disseminate good practice in mental health for precisely those new community services emerging to tackle such social exclusion. Does anyone at the Health Development Agency read HSJ ?

Dr Woody Caan Cambridge