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An analysis of 100 referrals for depression from primary care to an adult mental health service

Published online by Cambridge University Press:  18 September 2013

C. Rogers ,
S. Heatherington ,
M. Carroll ,
M. Leonard ,
W. Cullen  and
D. Meagher
C. Rogers
Affiliation:
Limerick Mental Health Services
S. Heatherington
Affiliation:
Limerick Mental Health Services
M. Carroll
Affiliation:
Limerick Mental Health Services
M. Leonard
Affiliation:
Limerick Mental Health Services Cognitive Disorders Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland
W. Cullen
Affiliation:
Cognitive Disorders Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland
D. Meagher*
Affiliation:
Limerick Mental Health Services Cognitive Disorders Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland
*
Address for correspondence: Professor D. Meagher, Room 01-017, Graduate Entry Medical School, University of Limerick, Ireland. Email david.meagher@ul.ie
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Abstract

Objectives

Improving the interface between primary care and mental health services is a key target in current healthcare policy in Ireland. This study examines the content of referrals from primary care to a community mental health service for apparent depression.

Method

We retrospectively reviewed the clinical records of 100 patients with depression who consecutively attended a specialist mental health service in Ireland's midwest region. Records were reviewed for demographic and clinical information provided by the doctor at the time of referral, subsequent service engagement, diagnosis and treatment initiated.

Results

There was considerable variation in the content and presentation of information contained in referral letters. Eleven per cent used structured HSE mental health referral forms. Seventy-six per cent of referrals contained clear information regarding name, address, symptoms and treatment previously initiated. Specifically, low mood, biological symptoms of depression and illness severity were documented in 43%, 34% and 27%, respectively. Suicide risk was documented in 20%. More detail was significantly associated with more severe illness. At initial specialist assessment, 71% had commenced antidepressant treatment, with 11% having received an adequate trial of a first antidepressant and 3% an adequate trial of two antidepressants. Two-thirds were diagnosed with mild/moderate depression. Initiation of antidepressant treatment was linked to subsequent diagnosis of depressive illness by mental health services (p < 0.001).

Conclusions

Our findings indicate variable referral practices from general practice to mental health in our region. Most referrals were for mild to moderate depression. Poor access to psychological services locally may be a key factor in this phenomenon.

Keywords

Depressionmental healthprimary carereferral
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 30 , Issue 4 , December 2013 , pp. 237 - 244
Copyright
Copyright © College of Psychiatrists of Ireland 2013 

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References

Age Concern (2008). Undiagnosed, Untreated, at Risk. The Experiences of Older People with Depression. Age Concern: London.Google Scholar
Akbari, A, Mayhew, A, Al Alawi, MA, Grimshaw, J, Winkens, R, Glidewell, E, Pritchard, C, Thomas, R, Fraser, C (2008). Interventions to improve outpatient referrals from primary care to secondary care. Cochrane Database of Systematic Reviews 8, CD005471, doi: 10.1002/14651858.CD005471.pub2.CrossRefGoogle ScholarPubMed
Album, D, Westin, S (2007). Do diseases have a prestige hierarchy? A survey amongst physicians and medical students. Social Science & Medicine 66, 182–188.CrossRefGoogle Scholar
Arroll, B, Khin, N, Kerse, N (2003). Screening for depression in primary care with two verbally asked questions: cross sectional study. British Medical Journal 327, 1144–1146.CrossRefGoogle ScholarPubMed
Banks, R, Gask, L (2008). It's time to talk: rekindling the relationship with primary care. Advances in Psychiatric Treatments 14, 84–85.CrossRefGoogle Scholar
Barth, J, Schumacher, M, Herrmann-Lingen, C (2004). Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosomatic Medicine 66, 802–813.CrossRefGoogle ScholarPubMed
Burbach, F (1997). GP referral letters to a community mental health team: an analysis of the quality and quantity of information. International Journal of Health Care Quality Association 10, 67–72.CrossRefGoogle ScholarPubMed
Burns, T (2004). Community Mental Health Teams. A Guide to Current Practices. Oxford University Press: Oxford.CrossRefGoogle Scholar
Campbell, C, Parsons, B, Loane, R (2008). Analysis of referral letters to a department of old age psychiatry. Irish Journal of Psychological Medicine 25, 24–28.CrossRefGoogle ScholarPubMed
Chew-Graham, CA, Slade, M, Montana, C, Stewart, M, Gask, L (2007). A qualitative study of referral to community mental health teams in the UK: exploring the rhetoric and the reality. BMC Health Services Research 7, 117.CrossRefGoogle ScholarPubMed
Cohen, A (2008). The primary care management of anxiety and depression: a GP's perspective. Advances in Psychiatric Treatments 14, 98–105.CrossRefGoogle Scholar
Copty, M (2004). Mental Health in Primary Care. ICGP/SWAHB: Dublin.Google Scholar
Copty, M, Whitford, D (2005). Mental health in general practice: assessment of current state and future needs. Irish Journal of Psychological Medicine 22, 83–86.CrossRefGoogle ScholarPubMed
Crawford, P, Carr, J, Knight, A, Chambers, K, Nolan, P (2001). The value of community mental health nurses based in primary care teams: ‘switching the light on in a cellar’. Journal of Psychiatric and Mental Health Nursing 8, 213–220.CrossRefGoogle Scholar
Department of Health and Children (2001). Primary Care: A New Direction. Quality and Fairness – A Health System For You. The Government Stationary Office: Dublin.Google Scholar
Department of Health and Children (2006). ‘A Vision for Change’. Report of the Expert Group on Mental Health Policy. The Government Stationary Office: Dublin.Google Scholar
Dowrick, C, Leydon, GM, McBride, A, Howe, A, Burgess, H, Clarke, P, Maisey, S, Kendrick, C (2009). Patients’ and doctors’ views on depression severity questionnaires incentivised in UK quality and outcomes framework: qualitative study. British Medical Journal 338, b663.CrossRefGoogle ScholarPubMed
Evans, A (1993). A study of the referral decision in general practice. Family Practice 10, 104–110.CrossRefGoogle ScholarPubMed
Gask, L, Lester, H (2008). Working together. Invited commentray on ‘The primary care management of anxiety and depression’. Advances in Psychiatric Treatments 14, 106–108.CrossRefGoogle Scholar
Gilbody, S, Whitty, P, Grimshaw, J, Thomas, R (2003). Educational and organizational interventions to improve the management of depression in primary care: a systematic review. The Journal of the American Medical Association 289, 3145–3151.CrossRefGoogle ScholarPubMed
Health Information and Quality Authority (2010). Standardising patient referral information: a draft national template for consultation. 14 December 2010.Google Scholar
Hegarty, K, Gunn, J, Blashki, G, Griffiths, F, Dowell, T, Kendrick, T (2009). How could depression guidelines be made more relevant and applicable to primary care. The British Journal of General Practice 59, e149–e156.CrossRefGoogle ScholarPubMed
Hilton, C, Bajal, P, Hagger, M, Taha, S, Warner, J (2008). What should prompt an urgent referral to a community mental health team? Mental Health in Family Medicine 5, 197–201.Google ScholarPubMed
Hull, SA, Jones, C, Tissier, JM, Eldridge, S, Maclaren, D (2002). Relationship style between GPs and community mental health teams affects referral rates. The British Journal of General Practice 52, 101–107.Google ScholarPubMed
Irish College of General Practitioners (2006). Guidelines for the Management of Depression and Anxiety Disorders in Primary Care. Health Services Executive. Kildare St., Dublin.Google Scholar
Kendrick, T, Dowrick, C, McBride, A, Howe, A, Clarke, C, Maisey, S, Moore, M, Smith, PW (2009). Management of depression in UK general practice in relation to scores on depression severity questionnaires: analysis of medical record data. British Medical Journal 338, b750.CrossRefGoogle ScholarPubMed
Kendrick, T, Simons, L, Mynors-Wallis, L, Gray, A, Lathlean, J, Pickering, R, Harris, S, Rivero-Arias, O, Gerard, K, Thompson, C (2006). Cost-effectiveness of referral for generic care or problem-solving treatment from community mental health nurses, compared with usual general practitioner care for common mental disorders: randomised controlled trial. British Journal of Psychiatry 189, 50–59.CrossRefGoogle ScholarPubMed
Kessler, D, Lloyd, K, Lewis, G, Gray, DP (1999). Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. British Medical Journal 318, 436–440.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, RL, Williams, JB (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606–613.CrossRefGoogle ScholarPubMed
Layard, R, Clark, D, Knapp, M, Mayraz, G (2006). Implementing NICE guidelines for depression and anxiety. A cost-benefit analysis. Paper for the Mental Health Policy Group. http://cep.lse.ac.uk/layard. Accessed 3rd July 2011.Google Scholar
Lester, H, Howe, A (2008). Depression in primary care: three key challenges. Postgraduate Medical Journal 84, 545–548. doi:10.1136/pgmj.2008.068387.CrossRefGoogle ScholarPubMed
Meagher, D, O'Brien, S, Pullela, A, Oshun, A, Brosnan, P (2009). Multidisciplinary activities in a community mental health service: relationship to health of the nation outcome scale scores and diagnosis. Psychological Bulletin 33, 273–275.Google Scholar
National Institute for Clinical Excellence (2004). Depression: Management of Depression in Primary and Secondary Care. Clinical Guideline 23. NICE: London. http://www.nice.org.uk/pdf/CG023quickrefguide.pdf.Google Scholar
Prins, MA, Verhaal, PF, Smolders, M, Laurant, MG, van der Meer, K, Spreeuwenberg, P, van Marwijk, HW, Penninx, BW, Bensing, JM (2010). Patient factors associated with guideline-concordant treatment of anxiety and depression in primary care. Journal of General Internal Medicine 25, 648–655.CrossRefGoogle ScholarPubMed
Raju, B, Meagher, D (2005). Patient-controlled benzodiazepine dose reduction in a community mental health service. Irish Journal of Psychological Medicine 22, 42–45.CrossRefGoogle Scholar
Ross, S, Moffat, K, Mcconnachie, A, Gordon, J, Wilson, P (1999). Sex and attitude: a randomized vignette study of the management of depression by general practitioners. The British Journal of General Practice 49, 17–21.Google ScholarPubMed
Shaw, I, Clegg Smith, KM, Middleton, H, Woodward, L (2005). A letter of consequence: referral letters from general practitioners to secondary mental health services. Qualitative Health Research 15, 116–128.CrossRefGoogle ScholarPubMed
Slade, M, Cahill, S, Kelsey, W, Leese, M, Powell, R (2002). Threshold 4: an evaluation of the threshold assessment grid as an aid to mental health referrals. Primary Care Mental Health 1, 45–54.Google Scholar
Slade, M, Gask, L, Leese, M, McCrone, P, Montana, C, Powell, R, Stewart, M, Chew-Graham, C (2008). Failure to improve appropriateness of referrals to adult community mental health services – lessons from a multi-site cluster randomized controlled trial. Family Practice 25, 181–190.CrossRefGoogle ScholarPubMed
Verhaak, PF, van der Lisdonk, EH, Bor, JH, Hutschemaekers, GJ (2000). GPs’ referral to mental health care during the past 25 years. The British Journal of General Practice 50, 307–308.Google ScholarPubMed
Williams, JW Jr, Katon, W, Lin, EH, Nöel, PH, Worchel, J, Cornell, J, Harpole, L, Fultz, BA, Hunkeler, E, Mika, VS, Unützer, J; IMPACT Investigators (2004). The effectiveness of depression care management on diabetes-related outcomes in older people. Annals of Internal Medicine 140, 1015–1024.CrossRefGoogle Scholar
World Health Organization (1992). Mental and Behavioral Disorders (F00-F99). The International Classification of Diseases, 10th Rev: ICD-10. World Health Organization: Geneva.Google Scholar
World Health Organization (2001). World Health Report 2001: Mental Health: New Understanding, New Hope. World Health Organization: Geneva, Switzerland.Google Scholar