Community mental health nurses' views of their role in the treatment of people with common mental disorders

Background: Tension is apparent between primary and secondary care services with regard to the treatment of people with common mental disorders (CMDs). Studies have consistently shown that general practitioners (GPs) would like direct access to community mental health nurses (CMHNs) for CMDs, despite a lack of evidence of effectiveness for this treatment approach. Policy initiatives direct community mental health nurses to concentrate their efforts on people with severe mental illness (SMI). This is an important issue as GPs take on practice-based commissioning. The views of CMHNs themselves are under-reported. Aim: To explore community mental health nurses' views concerning the nature of common mental disorders and their role in treatment. Design: Qualitative case study. Setting: Four NHS trusts providing mental health services in southern England. Methods: Six group discussions were undertaken with 37 CMHNs. Data were analysed using thematic content analysis. Results: Unlike GPs, CMHNs did not consider treating people with CMDs to be part of their role. While they had the skills for this work, they felt it would distract from their primary purpose of caring for people with SMI. Having to deal with 'inappropriate' referrals from GPs could be frustrating for nurses. However, they perceived a gap in provision for people with CMDs, and a need to facilitate speedy referral to secondary care for those people who did not respond to treatment in primary care. Conclusion: Notwithstanding the limitations of the methods of this study, the findings suggest that CMHNs are likely to resist any attempts to commission them to provide direct care for people with CMDs in primary care. Developing alternative partnership arrangements between secondary and primary care services may be more appropriate.