scholarly journals Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

2013 ◽  
Vol 1 (2) ◽  
pp. XXXX-XXXX ◽  
Author(s):  
C Dowrick ◽  
C Chew-Graham ◽  
K Lovell ◽  
J Lamb ◽  
S Aseem ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Research Programme ◽  
Psychosocial Interventions ◽  
Well Being ◽  
High Quality ◽  
Underserved Groups

BackgroundEvidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.Aim and objectivesOur aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.Methods and resultsExamination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.ConclusionsFurther research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.Study registrationCurrent Controlled Trials ISRCTN68572159.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

Primary Care Pediatrics and Child Psychopathology: A Review of Diagnostic, Treatment, and Referral Practices

PEDIATRICS ◽  
1986 ◽  
Vol 78 (6) ◽  
pp. 1044-1051 ◽  
Author(s):  
Elizabeth J. Costello
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Disorder ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Primary Care Providers ◽  
Health Problems ◽  
Group Practices ◽  
Primary Care Pediatricians

The quality of mental health care for children depends not only on specialist mental health services, but also on how effectively primary care providers identify, treat, and refer children with emotional and behavioral problems. Recent research has shown that primary care practitioners are the sole providers of mental health care to the majority of people with a mental disorder. For example, Regier et al1 calculated that in 1975 54.1% of persons with a mental disorder were treated only in a primary care or outpatient medical setting, with another 6% receiving care from both specialist mental health and primary care medical facilities. An additional 21.5% were not in treatment or received treatment from nonmedical agencies. If the data were extrapolated for all age groups, these rates would imply that only one child in five with a mental disorder is receiving specialist treatment, three are in the care of a pediatrician, and one is receiving no treatment. This would lead to the conclusion that pediatricians are, according to Regier et al,1 the de facto mental health service for most children in need of such care. It would lend support to the drive to increase pediatricians' awareness of, and training for, the mental health component of their work.2 In this paper, we review the published evidence as it applies to children. SCOPE This review includes the published studies of mental health problems diagnosed by primary care pediatricians, family practitioners, or pediatric nurse practitioners working in outpatient settings in the United States. These include private pediatric practices, group practices, health maintenance organizations (HMOs), and other types of prepaid group practices. The questions addressed are: (1) What proportion of the children seen by primary care pediatricians and their colleagues are diagnosed by them as having a mental disorder? (2) What proportion of children are referred for specialist evaluation and treatment? (3) What risk factors are associated with a higher probability of receiving a diagnosis of psychopathology? (4) How accurate are primary care pediatricians' diagnoses of mental health problems?

Die andere pandemie: inzichten in en suggesties voor een betere public mental health (care)

2021 ◽  
Author(s):  
K. VAN DEN BROECK
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Waiting Times ◽  
Public Mental Health ◽  
Well Being ◽  
Health Problems ◽  
Mental Wellbeing ◽  
Public Mental Health Care

That other pandemic: insights and suggestions for a better public mental health (care). Like Covid-19, mental health problems threaten to undermine our society and the personal well-being of many – perhaps more dormantly, but not less destructively. Many people suffer from mental health problems and high suicide rates, skyrocketing psychopharmaceutical use and endless waiting times suggest that the quality of care today – despite the efforts of dedicated professionals –is sub-optimal. These staggering figures make the rollout of a larger plan to prevent, early identify and promptly treat mental health problems an urgent matter. This article focuses on how we can intervene in the mental wellbeing of our population: what bottlenecks underlie the current situation, what societal changes need to be made, and what data can contribute in the matter.

Mental Health Practices of Ontario Family Physicians: A Study Using Qualitative Methodology

1997 ◽  
Vol 42 (9) ◽  
pp. 943-949 ◽  
Author(s):  
MA Craven ◽  
M Cohen ◽  
D Campbell ◽  
J Williams ◽  
Nick Kates
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Providers ◽  
Mental Health Problems ◽  
Family Physicians ◽  
Health Problems ◽  
Care Providers ◽  
Mental Health Care Providers

Objective: To obtain descriptions of how family physicians detect and manage mental health problems commonly encountered in their practices and how they function in their role as mental health care providers. Also, to elicit their perceptions of barriers to the delivery of optimal mental health care. Method: Focus groups with standardized questions were used to elicit descriptive data, opinions, attitudes, and terminology. Convenience samples of 10 to 12 physicians were chosen in each of Ontario's 7 health care planning regions, with a mixture of rural, urban, and university settings. Discussions were audiotaped, transcribed, analyzed, and recurring themes were extracted. Results: Family physicians' descriptions of the range of problems commonly encountered and their detection and management highlight the unique nature of mental health care in the primary care setting. The realities of family medicine, the undifferentiated nature of presenting problems, the long-term physician–patient relationship, and the frequent overlap of physical and mental health problems dictate an approach to diagnosis and treatment that differs from mental health care delivery in other settings. Difficulties in the relationship with local psychiatric services—accessing psychiatric care (especially for emergencies), poor communication with mental health care providers, and cumbersome intake procedures of many mental health services—were consistently identified as barriers to the delivery of optimal mental health care. Conclusions: This study confirms the importance of the family physician in the detection and management of mental health problems. It offers insights into how family physicians function in their role as mental health care providers and how they deal with diagnostic and management challenges that are specific to primary care. It also identifies barriers to the optimal delivery of mental health care in the primary care setting, including difficulties at the clinical interface between psychiatry and family medicine. Further studies are needed to explore these issues in greater depth.

Development and Implementation of a Collaborative Mental Health Care Program in a Primary Care Setting: The Ottawa Share Program

2008 ◽  
Vol 27 (2) ◽  
pp. 75-91 ◽  
Author(s):  
J. Robert Swenson ◽  
Tim Aubry ◽  
Katharine Gillis ◽  
Colleen Macphee ◽  
Nicholas Busing ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Family Physicians ◽  
Care Program ◽  
Implementation Evaluation ◽  
Access To Primary Care ◽  
Collaborative Mental Health Care

This article presents the results of a needs assessment of family physicians and residents concerning the provision of mental health care and an implementation evaluation of a multidisciplinary mental health service demonstration project, linking 2 family practices with mental health services of a general hospital. Family physicians and residents reported that collaborative mental health care provision would enhance but not replace their management of patients with mental health problems. The implementation evaluation found that collaborative care provided by a multidisciplinary mental health team co-located with family physicians was accepted by patients and valued by family physicians. Because of a shortage of family physicians, few patients from the mental health system who lacked family physicians were able to gain access to primary care through this project.

Maternal mental health: a shared care approach

2015 ◽  
Vol 17 (02) ◽  
pp. 175-183 ◽  
Author(s):  
Hua Li ◽  
Angela Bowen ◽  
Michael Szafron ◽  
John Moraros ◽  
Nazeem Muhajarine
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Primary Care Physicians ◽  
Mental Health Problems ◽  
Maternal Mental Health ◽  
Health Problems ◽  
Shared Care ◽  
Care Approach

BackgroundMaternal mental health problems affect up to 20% of women, with potentially deleterious effects to the mother and family. To address this serious problem, a Maternal Mental Health Program (MMHP) using a shared care approach was developed. A shared care approach can promote an efficient use of limited specialized maternal mental health services, strengthen collaboration between the maternal mental health care team and primary care physicians, increase access to maternal mental health care services, and promote primary care provider competence in treating maternal mental health problems.AimThe purpose of this research was to evaluate the impact of a MMHP using a shared care approach on maternal anxiety and depression symptoms of participants, the satisfaction of women and referring physicians, and whether the program met the intents of shared care approach (such as quick consultation, increased knowledge, and confidence of primary care physicians).MethodsWe used a pre and post cross-sectional study design to evaluate women’s depression and anxiety symptoms and the satisfaction of women and their primary care health provider with the program.FindingsDepression and anxiety symptoms significantly improved with involvement with the program. Women and physicians reported high levels of satisfaction with the program. Physician knowledge and confidence treating maternal mental health problems improved.ConclusionsShared care can be an effective and efficient way to provide maternal mental health care in primary health care settings where resources are limited.

scholarly journals Establishing a mental health liaison attachment with primary care

1997 ◽  
Vol 3 (4) ◽  
pp. 219-224 ◽  
Author(s):  
Tom Burns ◽  
Rob Bale
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
General Practitioner ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Health Problems

The role of the general practitioner (GP) in the care of individuals with mental health problems has long been recognised. Goldberg & Huxleys' (1980) pioneering work on the pathways to mental health care demonstrated that only a fraction of identified mental health problems are referred on to psychiatrists. Goldberg & Bridges (1987) estimated that between 20 and 25% of a GP's workload concerns mental health, with only about 5% referred on to psychiatrists. Shepherd (1991) insisted that the only real hope for significant improvement in mental health care lay in the improvement of GP provision – there will simply never be enough psychiatrists.

Access to mental health care in an inner-city health district. I: Pathways into and within specialist psychiatric services

1997 ◽  
Vol 170 (4) ◽  
pp. 312-316 ◽  
Author(s):  
M. J. Commander ◽  
S. P. Sashi Dharan ◽  
S. M. Odell ◽  
P. G. Surtees
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Inner City ◽  
Mental Health Problems ◽  
Psychiatric Morbidity ◽  
Psychiatric Services ◽  
Specialist Services ◽  
Epidemiological Surveys

BackgroundNeeds for mental health care are likely to be high in urban areas. Purchasers must assess the extent to which these are being met. The pathways to care model provides a framework for this purpose.MethodEpidemiological surveys of adults living in deprived multi-ethnic innercity catchment area were undertaken in psychiatric services, primary care and community settings. Estimated prevalence rates were calculated and the association between clinical and demographic factors and the use of psychiatric services examined.ResultsAround a third of people with mental health problems did not consult a GP. and half failed to have their problems recognised by their doctor. Access to psychiatric services and especially to inpatient care was highly restricted. Diagnosis and ethnicity had a marked influence on the use of specialist services.ConclusionsMany people with psychiatric morbidity are not receiving treatment either from primary care or specialist services. High levels of severe morbidity and compulsory admissions highlight the pressures placed on inner-city psychiatric services.

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