Continuing Medical Education

Psychiatry in primary care using the three-stage assessment

C A Draper, P Smith


  • Mental illness imposes a massive burden on all levels of service, including primary care.
  • Challenges particular to primary care include the overwhelming service loads and time/resource constraints.
  • A further challenge revolves around the frequent mismatch between undergraduate teaching and the clinical nature of psychiatric care in primary level clinics.
  • Clinical presentations at primary level are often nonspecific and undifferentiated, and complicated by comorbid medical illness and psychosocial stressors.
  • The three-stage assessment that embraces the core principles of family practice can be adapted to incorporate the psychiatric needs of patients in primary care and deliver a truly holistic and integrated assessment of their individual needs.
  • These adaptations need not involve additional training or the need for additional clinical tasks.
  • Psychiatric management requires continuity of care within an enduring therapeutic relationship, which provides the ideal framework within which a comprehensive assessment and management plan can be formulated.
  • Successful adaptations to the three-stage assessment could provide an effective (and efficient) model for the integration of psychiatry at the primary care level. 

Authors' affiliations

C A Draper, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

P Smith, Lentegeur Hospital and Department of Psychiatry, University of Cape Town, South Africa

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Three-stage assessment; primary care

Cite this article

South African Medical Journal 2014;104(1):74. DOI:10.7196/SAMJ.7722

Article History

Date submitted: 2013-11-12
Date published: 2013-11-19

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