Managing patients with severe mental illness in the primary care setting is often a daunting prospect to even the most experienced of healthcare professionals. The stigma associated with mental illness can be difficult to overcome, and many practitioners are unprepared for dealing with the mentally ill. Even counsellors can be left without proper training in severe mental health matters. This is a practical guide to managing mentally ill patients, focusing on the role between general practitioners and counsellors within the primary care setting. The proactive approach encourages a positive outlook and a ‘can do’ approach. This guide is ideal for general practitioners and all primary healthcare professionals, particularly counsellors and therapists.