Psychiatry and primary care: A global medical care

Patients suffering from psychiatric disorders have a decrease in life expectancy of 15 years compared to the general population. This excess mortality is not related predominantly to suicide but mostly to a higher frequency of somatic diseases, such as cardiovascular, neoplastic, metabolic diseases. Their high prevalence and their low diagnoses are related to a poorer access to screening, prevention and somatic care than in the general population. Indeed, we estimated that more than 60% of patients treated in public psychiatry do not have a general practitioner (GP) in France. The GP has a role in the coordination, prevention and management of patient health care circuit. To allow a better access to general practitioner, a consultation and a somatic network have been created in Lyon. The purpose is to bring the user back into the primary care system, to ensure a durable monitoring, and a better prevention of avoidable diseases. Patients without GP are oriented to the consultation by their referent psychiatry team. During three consultations with a doctor and a nurse, an assessment of the patient's overall health is realized as well as a synthesis and a redirection to the city network. This reinstatement also allows a better communication between somatic and psychiatric care, to insure a more global view of the patient. A work around the re-empowerment and social rehabilitation is carried out to re-anchor the person in the city and in the care, which every citizen is entitled.