How can we work more effectively across the interface between psychiatry and primary care?

Journal title RIVISTA SPERIMENTALE DI FRENIATRIA
Author/s Linda Gask
Publishing Year 2017 Issue 2017/1
Language English Pages 20 P. 107-126 File size 1728 KB
DOI 10.3280/RSF2017-001008
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

This paper reviews the range of ways in which the interface between primary and specialist mental health care may be structured. An effective working relationship at the interface between primary and specialist care is essential to ensure not only that those people who require specialist care are referred on by the General Practitioner (GP), but also that the GP is adequately supported to manage as many people as possible effectively within primary care. The traditional model of referral is problematic, and different ways have been tried to overcome these problems by managing demand, restructuring the care pathway and improving communication. Over the last 30 years newer more integrated models of care have been described such as link working, consultation-liaison and collaborative care. Collaborative care has been demonstrated to have better outcomes for patients than other novel models, but requires considerable change in the roles and working practices of professionals. There are both overt and covert barriers to implementing change. Opportunities for professionals to meet across the interface are essential for developing more efficient and successful models of working, and flexibility is a key personal attribute for mental health professionals working in this setting. Service users should be actively involved in all stages of implementation.

Keywords: Mental-health, primary-care, collaborative-care, referral, community.

  1. Ustun TB, Sartorius N. Mental illness in general health care: an international study. Chichester: John Wiley & Sons on behalf of the World Health Organization; 1995.
  2. Crabtree BF, Nutting PA, Miller WL, Stange KC, Stewart EE, Jaén CR. Summary of the National Demonstration Project and recommendations for the patient-centered medical home. The Annals of Family Medicine 2010; 8 (Suppl 1): S80-S90.
  3. Thomas L, Lewis G. The epidemiology of mental illness. In: Gask L, Lester H, Kendrick T, Peveler R, ed. Primary Care Mental Health. R. London: RCPsych Publications; 2009. p. 28-39.
  4. Goldberg D, Huxley P. Mental health in the community: the pathways to psychiatric care. London: Tavistock Publications; 1980.
  5. Reilly S, Planner C, Hann M, Reeves D, Nazareth I, Lester H. The role of primary care in service provision for people with severe mental illness in the United Kingdom. PloS one 2012; 15, 7(5): e36468.
  6. Hofmarcher MM, Oxley H, Rusticelli E. Improved health system performance through better care coordination. OECD Health Working Papers No 30. Paris: OECD Publishing; 2007. DOI: 10.1787/246446201766
  7. Souza R, Patterson S, Gandesha A, McGeorge M, Quirk A, Crawford M. Modelling the interface between primary care and specialist mental health services: A tool for commissioning. London: Royal College of Psychiatrists; 2015.
  8. Gask L. Depression kills so why arent people getting better NHS care? The Guardian 16 March 2016. --https://www.theguardian.com/healthcarenetwork/2016/mar/16/depression-suicide-nhs-mental-health-problem. (last accessed 15.02.2017)
  9. Gask L, Evans M, Kessler D. Personality disorder. The British Medical Journal 2013; 347(7924): 28-32.
  10. Chew-Graham C, Slade M, Montana C, Stewart M, Gask L. A qualitative study of referral to community mental health teams in the UK: exploring the rhetoric and the reality. BMC Health Services Research 2007; 7(1): 117. DOI: 10.1186/1472-6963-7-117
  11. Bower P, Gilbody S. Managing common mental health disorders in primary care: conceptual models and evidence base. British Medical Journal 2005; 330(7495): 839.
  12. Fuller JD, Perkins D, Parker S, Holdsworth L, Kelly B, Roberts R et al. Effectiveness of service linkages in primary mental health care: a narrative review part 1. BMC Health Services Research 2011; 11(1): 72. DOI: 10.1186/1472-6963-11-72
  13. Gask L, Khanna T. Ways of working at the interface between primary and specialist mental healthcare. The British Journal of Psychiatry 2011; 198(1): 3-5.
  14. Raine R, Carter S, Sensky T, Black N. ‘Referral into a void’: opinions of general practitioners and others on single point of access to mental health care. Journal of the Royal Society of Medicine 2005; 98(4): 153-7.
  15. Sibbald B, Addington-Hall J, Brenneman D, Freeling P. Counsellors in English and Welsh general practices: their nature and distribution. British Medical Journal 1993; 306(6869): 29-33.
  16. Clark DM. The English Improving Access to Psychological Therapies (IAPT) Program. Dissemination and implementation of evidence-based psychological interventions. In: McHugh RK, Barlow DH, eds. Dissemination and Implementation of Evidence-Based Psychological Treatments. New York: Oxford University Press; 2012. p. 61-77.
  17. Churchill R, Hunot V, Corney R, Knapp M, McGuire H, Tylee A et al. A systematic review of controlled trials of the effectiveness and costeffectiveness of brief psychological treatments for depression. Health Technology Assessment 2002; 5(35): 1-73.
  18. Bower P, Knowles S, Coventry PA, Rowland N. Counselling for mental health and psychosocial problems in primary care. Cochrane Database of Systematic Reviews 2011; 9.
  19. Fonagy P, Rost F, Carlyle JA, McPherson S, Thomas R, Pasco Fearon RM et al. Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression: the Tavistock Adult Depression Study (TADS). World Psychiatry 2015; 14(3): 312-21.
  20. National Institute for Health and Clinical Excellence (2011). Common mental health disorders: identification and pathways to care. NICE guideline (CG123). -- http://guidance.nice.org.uk/CG123 (last accessed 15.02.2017)
  21. Croudace T, Evans J, Harrison G, Sharp DJ, Wilkinson E, McCann GE et al. Impact of the ICD-10 Primary Health Care (PHC) diagnostic and management guidelines for mental disorders on detection and outcome in primary care. The British Journal of Psychiatry 2003;182(1): 20-30.
  22. Craven M, Bland R: Better practices in collaborative mental health care: an analysis of the evidence base. Canadian Journal of Psychiatry – Revue Canadienne de Psychiatrie 2006; 51: 7S-72S.
  23. Sobell MB, Sobell LC. Stepped care as a heuristic approach to the treatment of alcohol problems. Journal of consulting and clinical psychology 2000; 68(4): 573.
  24. Newman M. Recommendations for a cost-offset model of psychotherapy allocation using generalized anxiety disorder as an example. Journal of Consulting and Clinical Psychology 2000; 68: 549–555. DOI: 10.1037//0022-006X.68.4.549
  25. Richards DA, Bower P, Pagel C, et al. Delivering stepped care: an analysis of implementation in routine practice. Implementation Science : IS. 2012; 7:3. DOI: 10.1186/1748-5908-7-3
  26. Ekers D, Webster L. An overview of the effectiveness of psychological therapy for depression and stepped care service delivery models. Journal of Research in Nursing 2013;18(2): 171-84. DOI: 10.1177/1744987112466254
  27. Gask L. What happens when psychiatric out-patients are seen once only? The British Journal of Psychiatry 1986; 148(6): 663-6.
  28. Lester HAT, Wilson S, Jowett S, Roberts L. A cluster randomised controlled trial of patient-held medical records for people with schizophrenia receiving shared care. British Journal of General Practice 2003; 197-203.
  29. McLaren P. Telemedicine and telecare: what can it offer mental health services?. Advances in Psychiatric Treatment 2003; 9(1): 54-61.
  30. Fortney JC, Pyne JM, Turner EE, Farris KM, Normoyle TM, Avery MD et al. Telepsychiatry integration of mental health services into rural primary care settings. International Review of Psychiatry 2015; 27(6): 525-39. DOI: 10.3109/09540261.2015.1085838
  31. Starfield B. Primary care: Balancing health needs services and technology. Oxford: Oxford University Press; 1998.
  32. Batterham R, Southern D, Appleby N, Elsworth G, Fabris S, Dunt D et al. Construction of a GP integration model. Social Science & Medicine 2002; 54(8): 1225-41. DOI: 10.1016/S0277-9536(01)00092-2
  33. Simoens S, Scott A. What determines integration in primary care? Theory and evidence. University of Aberdeen, Health Economics Research Unit, Discussion Paper 04/99; 1999.
  34. Collins C, Hewson DL, Munger R, Wade T. Evolving models of behavioral health integration in primary care. New York, NY: Milbank Memorial Fund; 2010.
  35. Byng R, Jones R, Leese M, Hamilton B, McCrone P, Craig T. Exploratory cluster randomised controlled trial of shared care development for long-term mental illness. British Journal of General Practice 2004; 54 (501): 259-266.
  36. Gask L, Sibbald B, Creed F. Evaluating models of working at the interface between mental health services and primary care. The British Journal of Psychiatry 1997; 170(1): 6-11.
  37. Harkness EF, Bower PJ. On-site mental health workers delivering psychological therapy and psychosocial interventions to patients in primary care: effects on the professional practice of primary care providers. Cochrane Database of Systematic Reviews 2009; 1.
  38. Creed FR, Marks B. Liaison psychiatry in general practice: a comparison of the liaison-attachment scheme and shifted outpatient clinic models. The Journal of the Royal College of General Practitioners 1989; 39(329): 514-7.
  39. Menchetti M, Tarricone I, Bortolotti B, Berardi D. Integration between general practice and mental health services in Italy: guidelines for consultation-liaison services implementation. International Journal of Integrated Care 2006; 6(2).
  40. Cape J, Whittington C, Bower P. What is the role of consultation–liaison psychiatry in the management of depression in primary care? A systematic review and meta-analysis. General Hospital Psychiatry 2010; 32: 246– 54.
  41. Bower P, Gask L. The changing nature of consultation-liaison in primary care: bridging the gap between research and practice. General Hospital Psychiatry 2002; 24(2): 63-70. DOI: 10.1016/S0163-8343(01)00183-9
  42. Curbside consultations. Psychiatry (Edgmont) 2010; 7(5): 51–53.
  43. Midgley S, Burns T, Garland C. What do general practitioners and community mental health teams talk about? Descriptive analysis of liaison meetings in general practice. British Journal of General Practice 1996; 46(403): 69-71.
  44. Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. The Milbank Quarterly 1996; 1:511-44. DOI: 10.2307/3350391
  45. Katon W, Von Korff M, Lin E, Simon G. Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse. General Hospital Psychiatry 2001; 23(3): 138-44.
  46. Richards DA, Hill JJ, Gask L, Lovell K, Chew-Graham C, Bower P et al. Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial. The British Medical Journal 2013; 347: f4913.
  47. Gunn J, Diggens J, Hegarty K, Blashki G. A systematic review of complex system interventions designed to increase recovery from depression in primary care. BMC Health Services Research 2006; 6(1): 88. DOI: 10.1186/1472-6963-6-88
  48. Coventry PA, Hudson JL, Kontopantelis E, Archer J, Richards DA, Gilbody S et al. Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials. PloS one 2014; 9(9): e108114.
  49. Panagioti M, Bower P, Kontopantelis E, Lovell K, Gilbody S, Waheed W et al. Association between chronic physical conditions and the effectiveness of collaborative care for depression: an individual participant data meta-analysis. Jama Psychiatry 2016; 73(9): 978-89.
  50. Menchetti M, Sighinolfi C, Di Michele V, Peloso P, Nespeca C, Bandieri PV et al. Effectiveness of collaborative care for depression in Italy. A randomized controlled trial. General Hospital Psychiatry 2013; 35(6): 579-86.
  51. Bauer MS, McBride L, Williford WO, Glick H, Kinosian B, Altshuler L et al. Collaborative care for bipolar disorder: part II. Impact on clinical outcome, function, and costs. Psychiatric Services 2006; 57(7): 937-45.
  52. Druss BG, Silke A, Compton MT, Rask KJ, Zhao L, Parker RM. The Primary Care Access Referral, and Evaluation (PCARE) study: a randomized trial of medical care management for community mental health settings. The American Journal of Psychiatry 2010; 167(2): 151.
  53. Meadows GN, Harvey CA, Joubert L, Barton D, Bedi D. Best practices: the consultation-liaison in primary-care psychiatry program: a structured approach to long-term collaboration. Psychiatric Services 2007; 58(8): 1036- 8.
  54. Lee J, Gask L, Roland M, Donnan S. Primary care led commissioning of mental health services: lessons from total purchasing. Journal of Mental Health 2002; 11(4): 431-9.
  55. [55] Gask L. Overt and covert barriers to the integration of primary and specialist mental health care. Social Science & Medicine 2005; 61(8): 1785-94.
  56. Fuller JD, Perkins D, Parker S, Holdsworth L, Kelly B, Roberts R et al. Building effective service linkages in primary mental health care: a narrative review part 2. BMC Health services research 2011; 11(1): 66. DOI: 10.1186/1472-6963-11-66

Linda Gask, How can we work more effectively across the interface between psychiatry and primary care? in "RIVISTA SPERIMENTALE DI FRENIATRIA" 1/2017, pp 107-126, DOI: 10.3280/RSF2017-001008