This paper reviews the range of ways in which the interface between primary and specialist mental health care may be structured. An effective working relationship at the interface between primary and specialist care is essential to ensure not only that those people who require specialist care are referred on by the General Practitioner (GP), but also that the GP is adequately supported to manage as many people as possible effectively within primary care. The traditional model of referral is problematic, and different ways have been tried to overcome these problems by managing demand, restructuring the care pathway and improving communication. Over the last 30 years newer more integrated models of care have been described such as link working, consultation-liaison and collaborative care. Collaborative care has been demonstrated to have better outcomes for patients than other novel models, but requires considerable change in the roles and working practices of professionals. There are both overt and covert barriers to implementing change. Opportunities for professionals to meet across the interface are essential for developing more efficient and successful models of working, and flexibility is a key personal attribute for mental health professionals working in this setting. Service users should be actively involved in all stages of implementation.
Keywords: Mental-health, primary-care, collaborative-care, referral, community.