Hostname: page-component-5c6d5d7d68-vt8vv Total loading time: 0.001 Render date: 2024-08-14T21:51:27.090Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluating models of working at the interface between mental health services and primary care

Published online by Cambridge University Press:  02 January 2018

Linda Gask ,
Bonnie Sibbald  and
Francis Creed
Linda Gask*
Affiliation:
National Primary Care Research and Development Centre, Manchester
Bonnie Sibbald
Affiliation:
National Primary Care Research and Development Centre, Manchester
Francis Creed
Affiliation:
Department of Psychiatry, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL
*
Dr L. Gask, NPCRDC, The University of Manchester, 5th Floor, Williamson Building, Oxford Road, Manchester M13 9PL
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

This paper examines the feasibility of evaluating innovative models of working at the interface between primary care and secondary mental health services.

Method

Methodological problems relevant to evaluation of innovative models of working at the interface are discussed.

Results

Although there is some evidence that neurotic disorders can be more cost-effectively treated in primary care, many general practitioners (GPs), and possibly some patients, prefer referral to community mental health teams and community psychiatric nurses, which are provided by the secondary health care services. Since the latter are provided with the intention of improving serious mental illness their involvement in the care of neurotic illness can lead to tensions between GPs, local health authorities and service providers. There is little evidence to suggest that psychiatrists working in health centres using the ‘shifted out-patient’ model have eased this problem. By contrast the ‘consultation-liaison’ (C-L) model has a number of theoretical advantages; referrals to secondary care should be limited to those most in need of this level of expertise and GP management skills should improve, so leading to better quality of care for patients who are not referred.

Conclusion

Studies comparing the different models of service delivery are required to address the tensions that have arisen following changes in government policy. Further work is also needed to develop the necessary research tools.

Type
Review Article
Information
The British Journal of Psychiatry , Volume 170 , Issue 1 , January 1997 , pp. 6 - 11
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Audit Commission (1994) Finding a Place: A Review of Mental Health Services for Adults. London: Her Majesty's Stationery Office.Google Scholar
Ballay, J., Black, M. & Wilkin, D. (1994) Specialist outreach clinics in general practice. British Medical Journal, 308, 1083–1086.Google Scholar
Balestrleri, M. Williams, P. & Wilkinson, G. (1988) Specialist mental health care in general practice: a meta-analysis. Psychological Medicine. 18, 711–718.Google Scholar
Bennett, L., May, C. & Wolfson, D. J. (1993) Sharing care between hospital and the community: a critical review of developments in the UK. Health and Social Care. 2, 105–112.CrossRefGoogle Scholar
Boardman, A. P., Bouras, N. & Cundy, J. (1987) The Mental Health Advice Centre in Lewisham. Service Usage: Trends for 1978 to 1984, 1st edn. Research report No. 3. London: National Unit for Psychiatric Research and Development.Google Scholar
Brown, L. M. & Tower, J. E. C. (1990) Psychiatrists in primary care: would general practitioners welcome them? British Journal of General Practice. 40, 369–371.Google Scholar
Brown, R. M., Strathdee, G., Christie-Brown, J. R., et al (1988) A comparison of referrals to primary care and hospital out-patient clinics. British Journal of Psychiatry. 153, 168–173.CrossRefGoogle ScholarPubMed
Campbell, M. (1995) Comparison of the quality of care between a general hospital based service and a community psychiatric team linked to primary care in the management of acute mental illness. MSc thesis. University of Manchester Google Scholar
Creed, F., & Marks, B. (1989) Liaison psychiatry in general practice: a comparison of the liaison attachment scheme and shifted out-patient clinic models, Journal of the Royal College of General Practitioners. 39 514–517.Google Scholar
Creed, F., & Marks, B., Gowrisunkur, J., Russell, E., et al (1990) General practitioner referral rates to district psychiatry and psychology services. British Journal of General Practice. 40, 450–454.Google ScholarPubMed
Darling, C. & Tyrer, P. (1990) Brief encounters in general practice: liaison in general practice psychiatry clinics. Psychiatric Bulletin. 14, 592–594.Google Scholar
Deys, C., Dowling, E. & Golding, V. (1989) Clinical psychology: a consultative approach in general practice. Journal of the Royal College of General Practitioners. 39, 342–344.Google Scholar
Falloon, I. & Fadden, G. (1993) Integrated Mental Health Care: A Comprehensive Community-based Approach. Cambridge: Cambridge University Press.Google Scholar
Ferguson, B. G. & Varnam, M. A. (1994) The relationship between primary care and psychiatry: an opportunity for change. British Journal of General Practice. 44, 527–530.Google Scholar
Gask, L. (1992) Training general practitioners to detect and manage emotional disorders. International Review of Psychiatry 4 293–300.CrossRefGoogle Scholar
Goldberg, D. & Huxley, P. (1992) Common Mental Disorders: A Bio-Social Model. London: Routledge.Google Scholar
Gournay, K. & Brooking, J. (1994) Community psychiatric nurses in primary health care. British Journal of Psychiatry. 165, 231–238.Google Scholar
Grace, J. & Armstrong, D. (1987) Referral to hospital: Perceptions of patients, general practitioners and consultants about necessity and suitability of referral. Family Practice, 4, 170–175.Google Scholar
Hafner, H. & Klug, J. (1982) The impact of an expanding community mental health service on patterns of bed usage: evaluation of a four year period of implementation. Psychological Medicine. 12, 177–190.Google Scholar
Holden, J. M., Sagovsky, R. & Cox, J. (1989) Counselling in a general practice setting: Controlled study of health visitor intervention in treatment of post-natal depression. British Medical Journal. 298, 223–226.CrossRefGoogle Scholar
Jackson, M. G., Gater, R., Goldberg, D. P., et al (1993) A new community mental health team based in primary care. British Journal of Psychiatry 162, 375–384.CrossRefGoogle ScholarPubMed
Kendrick, T. Sibbald, B., Burns, T., et al (1991) Role of general practitioners in the care of long-term mentally ill patients. British Medical Journal. 302, 508–510.CrossRefGoogle ScholarPubMed
Kessel, N. (1963) Who ought to see a psychiatrist? Lancet, i, 1092–1095.CrossRefGoogle Scholar
Mann, A. H., Jenkins, R. & Belsey, E. (1981) The 12-month outcome of patients with neurotic illness in general practice. Psychological medicine. II 535–550.Google Scholar
Mental Health Foundation (1994) Creating Community Care. London: Mental Health Foundation.Google Scholar
Mitchell, A. R. K. (1985) Psychiatrists in primary health care settings. British Journal of Psychiatry 147. 371–379 Google Scholar
Morgan, D. (1989) Psychiatric cases: an ethnography of the referral process. Psychological Medicine. 19, 743–753.Google Scholar
NHS Management Executive (1991) Integrating Primary and Secondary Care. London: Department of Health.Google Scholar
Onyett, S., Heppleston, T. & Bushnell, D. (1994) The Organisation and Operation of Community Mental Health Teams in England London: Sainsbury Centre for Mental Health.Google Scholar
Onyett, S., Heppleston, T., Bushnell, D., Pillinger, T. & Muijen, M. (1995) Making Community Mental Health Teams Work. London: Sainsbury Centre for Mental Health.Google Scholar
Patmore, C. & Weaver, T. (1991) Community Mental Health Teams: Lessons for Planners and Managers. Report to the Department of Health. London: Good Practices in Mental Health.Google Scholar
Paykel, E. Mangen, S. P., Griffith, J. H. et al (1982) Community psychiatric nursing for neurotic patients: a controlled trial. British Journal of Psychiatry 140, 573–581.Google Scholar
Peck, E. (1994) Community mental health centres. Journal of Mental Health. 3, 149–150.Google Scholar
Pilgrim, D. & Rogers, A. (1993) Mental health service users' views of medical practitioners, Journal of Interprofessional Care, 7, 167–176.Google Scholar
Roland, M. & Coulter, A. (eds) (1992) Hospital Referrals. Oxford: Oxford University Press.Google Scholar
Royal College of General Practitioners (1993) Shared care of patients with mental health problems (Occasional paper 60). London: Royal College of General Practitioners.Google Scholar
Salinsky, J. & Jenkins, G. C. (1994) Counselling in general practice. British Journal of General Practice. 44, 194–195.Google Scholar
Sayce, L., Craig, T. K. J. & Boardman, A. P. (1991) The development of community mental health centres in the UK. Social Psychiatry and Psychiatric Epidemiology 26, 14–22.CrossRefGoogle Scholar
Sibbald, B., Addington-Hall, J., Brenneman, D. et al (1993) Counsellors in English and Welsh general practices: their nature and distribution. British Medical Journal. 306, 29–33.Google Scholar
Scott, A. I. F. & Freeman, C. P. L. (1992) Edinburgh primary care depression study; treatment outcome, patient satisfaction and cost after 16 weeks. British Medical Journal, 304 883–887.CrossRefGoogle Scholar
Stansfield, S. A., Leek, C. A., Travers, W. et al (1992) Attitudes to community psychiatry among urban and rural general practitioners. British Journal of General Practice, 42, 322–325.Google Scholar
Strathdee, G. (1988) Psychiatrists in primary care: the general practitioner viewpoint. Family Practice, 5, 111–115.Google Scholar
Strathdee, G. (1993) The Nunhead Service: A Community Mental Health Service with a focus in Primary Care. PRISM Occasional Paper 13.Google Scholar
Strathdee, G. (1994) Psychiatry and general practice – a psychiatric perspective. In Psychiatry and General Practice Today(eds Pullen, I., Wilkinson, G., Wright, A., et al). London: Royal College of Psychiatrists and Royal College of General Practitioners.Google Scholar
Strathdee, G., King, M. B., Arya, R., et al (1990) A standardised assessment of patients referred to primary care and hospital psychiatric clinics. Psychological Medicine, 20, 219–224.CrossRefGoogle ScholarPubMed
Strathdee, G., King, M. B., Arya, R., & Thornicroft, G. (1991) The principles of setting up mental health services in the community In Principles of Social Psychiatry(eds Leff, J. & Bhugra, D.). Oxford: Blackwell.Google Scholar
Strathdee, G., King, M. B., Arya, R., Thornicroft, G. & A Williams, P. (1984) A survey of psychiatrists in primary care: the silent growth of a new service, Journal of the Royal College of General Practitioners, 34, 615–618.Google ScholarPubMed
Thomas, R. V. R. & Corney, R. H. (1992) A survey of links between mental health professionals and general practice in six district health authorities. British Journal of General Practice. 42, 358–361.Google Scholar
Tyrer, P. (1984) Psychiatric clinics in general practice: an extension of community care. British Journal of Psychiatry, 145, 9–14.CrossRefGoogle ScholarPubMed
Tyrer, P., Sievewright, N. & Woilerton, S. (1984) General practice psychiatric clinics. Impact on psychiatric services. British Journal of Psychiatry 145, 15–19.Google Scholar
Warner, R., Gater, R., Jackson, G., et al (1993) The effects of a new mental health service based in primary care on the work of general practitioners. British Journal of General Practice, 43, 507–511.Google Scholar
Wooff, K., Goldberg, D. & Fryers, T. (1986) Patients in receipt of community psychiatric nursing care in Salford. 1976–1982. Psychological Medicine. 16, 407–414.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.