The new MRCGP curriculum devotes a whole section to the care of people with mental health problems—and rightly so, for up to 30% of us will have some kind of significant episode of psychological disturbance in our lifetimes. Far more of us suffer transient but problematic psychological distress, especially when we or others for whom we care are unwell. So the GP registrar doing a routine clinic in UK general practice will find that as many as one in four of their patients are experiencing psychological symptoms, with higher rates in the elderly. Previous articles have covered the specific tasks of performing mental health assessments and diagnosing depression: this article aims to review the broader context of psychological distress in the consultation. It pays additional attention to factors associated with psychological distress to which GPs and other primary care staff should be alert and to ways of addressing these in a sophisticated and humane manner. Finally, I address the question of self-management—that is minimizing the ‘human sponge’ effect often incurred by empathic GPs at the start of training.