This chapter draws on the conceptual framework developed in our previous work (Rogers & Pilgrim, 2005). The aim is bring together a sociological understanding of mental health in the context of primary care mental health (see also Chapter 1). Until recently, such an understanding of mental health in primary care would have simply extended a traditional focus on psychiatry. However, in a post-asylum world in many high-income countries, new service arrangements have placed primary care more centre stage. Moreover, these service arrangements are part of a wider reorientation in Western civil society regarding mental health problems (Pilgrim & Rogers, 1994). Not only are ‘common mental health problems’ now given greater political salience than in the past, but those previously warehoused in the psychiatric system are, for the bulk of their lives, now ‘managed’ in primary care. Matters of ‘social inclusion’ pertaining to the latter group are addressed in community, not hospital settings, potentially making primary care workers more pertinent in their role than in the past and maybe even in relation to their secondary care colleagues.
The newly emergent field of primary care mental health
In this chapter, primary care (as a field of activity) and the individual are viewed as inextricably linked. In referring to the work of Mauss (1934) and Bourdieu (1977), we explore primary care as a new and distinctive ‘field’ of activity, exchange and ‘habitus’, a set of dispositions that generate practices and perceptions of the way in which people encounter primary care. Primary care presents technologies and relationships. Patients respond to its ministrations and their actions; thoughts and feelings are thus governed and shaped by these new practices (or they are resisted and rejected). The actions and dispositions of individuals are influenced by material circumstances and their social position within wider society. Their group membership is important, given the variable and unequal relationship that exists between social groups. This complex intersection of individual experience and action with social processes is now explored further.
The changing status and role of general practitioners and service users
While primary care has managed common distress for a long time, little theoretical attention has been paid to it as a primary provider of mental healthcare in its totality, for all-comers. This is because, until relatively recently, general practice functioned as a referral and support system for the putatively more expert secondary care, or ‘specialist’, mental healthcare system.