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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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