Obstacles to effective treatment of depression: a general practice perspective

R Telford

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Mental Health Treatment and Access Psychiatric care and mental health services Primary Care and Health Outcomes

Abstract

BACKGROUND: The Clinical Standards Advisory Group (CSAG) was asked by UK health ministers to advise on the standards of clinical care attainable for people with depression. The GP survey reported here is one part of a multicomponent UK-wide study of services for depression that also included visits to a sample of services and structured patient telephone interviews. OBJECTIVES: The aim of this study was to survey GPs' perceptions of the availability and quality of primary and community-based services for people with depression, and to seek their views on barriers to the provision of good clinical services. METHODS: A structured postal questionnaire was sent to all GPs (3530) in the 11 geographical areas visited during the CSAG study. RESULTS: A total of 1703 (48%) GPs returned the questionnaire. The main obstacles to providing a good service for people with depression included not having enough time, a lack of services to refer to and difficulty in accessing services. More than half of the respondents (58%) were aware of guidelines for the management of depression, and 62% had attended a teaching session on depression within the last 3 years. Factors that influenced GPs to refer people with depression to other services were risk to the patient, a clear need for specialist treatment and the need for assessment. Overall, GPs appeared to be satisfied with the quality of specialist services. CONCLUSIONS: GPs appeared to view obstacles to providing effective treatment of depression as being more allied to external issues, in particular service provision, rather than internal factors such as their own knowledge and skills. The study revealed continuing concerns over excessive workload, and longstanding difficulties with the interface between primary and secondary mental health services.

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References

1996What Works for Whom?: A Critical Review of Psychotherapy Research 1995Functioning and Well-being Outcomes of Patients With Depression Compared With Chronic General Medical Illnesses 1990Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research.1999The World Health Report 1999. Making a Difference 1992Recognition and management of depression in general practice: consensus statement.2000Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy and usual general practitioner care in the management of depression as well as mixed anxiety and depression in primary care.1985Unrecognised depression in general practice.1997Barriers to the diagnosis of depression in primary care.

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2010Conditions That Influence a Primary Care Clinician's Decision to Refer Patients for Depression Care 2012Attitudes of primary care physicians towards patients with mental illness in H ong K ong

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