There is continuing support both politically and professionally for the provision of mental health care within primary care (Department of Health, 1999; The Scottish Office, 1993; 1997; 1998). However tensions exist between the supply and demand for mental health resources in primary care (Department of Health, 2000). In addition to resources, perceptions of need, knowledge and training are likely to influence the services offered and the uptake of these. This study reviews general practitioners’ (GPs) and patients’ perceptions of need, availability of services and GPs’ ability to access mental health services in two local areas using a new assessment tool. The Mental Health Management Options (MHMO) form, a brief instrument, was developed to provide information about GPs’ preferred and actual management options with people experiencing mild to moderate mental health difficulties seen during routine consultations

Sixteen GPs each completed 10 copies of the MHMO, providing data on 160 consultations. Analysis found that discrepancies arose in 69% (n = 109) of the consultations in relation to the action GPs wished to take but were unable to do so. This was related to the inability to access services, to patients who declined to follow suggested management options and to a lack of time and/or ability to manage the patient.

This study highlighted the barriers GPs face in managing people with mild to moderate mental health problems in primary care but also demonstrated the content validity and utility of the MHMO. The MHMO may be a useful new tool in identifying GPs’ perceptions of patterns of management and gaps in services.