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

Linda L Gask · Bonnie Sibbald · Francis H Creed

182 citations0/0 files storedThe British Journal of Psychiatry

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Psychiatric care and mental health services Mental Health Treatment and Access Healthcare Systems and Technology

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.

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References

1992Common mental disorders : a bio-social model 1992Edinburgh primary care depression study: treatment outcome, patient satisfaction, and cost after 16 weeks.1981The twelve-month outcome of patients with neurotic illness in general practice 1994Specialist outreach clinics in general practice

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