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This study investigated the obstacles for primary care physicians (PCPs) to managing mental health problems in Hong Kong. Focus group data collected from PCPs and psychiatrists were used to construct a questionnaire for a quantitative survey with 516 PCPs respondents. The results showed that their commonly perceived obstacles were lack of timely access to public psychiatrists, lack of feedback from both public and private psychiatrists after referrals; as well as patients’ reluctance to be referred. Factor analysis and correlational analysis found that the numbers of mental health patients treated by the PCPs were mainly determined by the PCPs’ own clinical constraints, including limited confidence in diagnosis and management, time constraint, and limited job satisfaction.