Dr Cohen is one of those rare, but fortunately increasing breeds of general practitioners, someone with experience in both primary care and mental health. His work in south London has been pioneering, in particular around his creative use of fundholding mechanisms to create a service that crossed geographical boundaries.
He established a primary care mental health service that defined access not by the patient's address, but instead by their registration to his practice, a forerunner to the primary care group concept.
Dr Cohen has also been instrumental in promoting the concept of primary care mental health as an entity separate to mental health. He recognises the important role of the GP, working together with other members of the primary healthcare team, in liaison with mental health services, to provide co-ordinated care. He also recognises the importance of primary care mental health commissioning, which is vital if GPs are to have responsibilities with the formation of primary care trusts for commissioning.
Primary Care Mental Health explains the complexity of primary care and the new systems, and tries to place in context the extent of mental health morbidity in primary care. It reviews established work but also presents new studies: for example, a survey carried out by the Sainsbury Centre for Mental Health (Dr Cohen is its primary care mental health lead) looking at skills and attitudes of managers who commission mental health services in health authorities. Not surprisingly, these managers were too overworked and underskilled to commission services effectively.
This monograph leads the reader through the implications of the national service framework for mental health. It should be read by everyone with mental health commissioning responsibilities.
It also provides a reference point for those wanting to understand primary care mental health from a primary care standpoint, unlike many other pieces of work on this subject that are written from a secondary care view.
If I have a criticism it is perhaps that substance misuse, a major cause of morbidity in primary care, has been missed out. In particular, the policy changes around the delivery of drug treatment services and the development of shared care. Maybe It is a subject for another monograph?