A Canadian study investigating the factors that help and hinder GPs in providing care to patients with mental disorders also rings many bells locally.
Facilitators included being paid a salary or hourly fees, having longer time slots for consultations, having psychosocial mental health care teams based on site, and having access to multidisciplinary assessment, meetings and trainings.
Other enabling features were knowing mental healthcare resources and professionals, formal referral procedures, good communication between practitioners, and being informed about patients’ treatment following referral.
The study – profiled below in the latest update from the Primary Health Care Research and Information Service (better known as PHC RIS) – also suggests (indirectly) the qualities that patients might look for in a doctor.
These include GPs who are more confident or enthusiastic about treating patients with mental disorders, who have undergone more continuing medical education in mental healthcare, who favour multidisciplinary care and who are empathetic and good listeners.
The factors that help and hinder GPs when it comes to managing patients with mental disorders
Petra Bywood writes:
Mental health problems are one of the leading causes of morbidity and comorbidity worldwide. Approximately 20% of Australians experience a mental health problem each year and for most of those who seek health services, their GP is the primary point of contact (AIHW).
Given the prevalence of mental health problems, and the demand for treatment through primary care, GPs’ skills in this area are being challenged beyond their training and a large proportion of patients’ mental health problems are going undetected or inadequately treated.
This study investigated GPs’ management of mental disorders in Quebec – the strategies they employed, the impact on their practices and the barriers and enablers to mental health management.
Using a mixed methods approach, 60 GPs were interviewed. They reported that at least 20% of consultations involved patients with mental disorders, many of whom also had a physical illness and substance abuse problems. While GPs were generally comfortable managing common mental health problems (e.g., anxiety and depression), they found serious mental disorders, complex problems or concomitant substance use much more challenging.
GPs’ readiness to manage patients with mental health problems was enabled by: remuneration by salary or hourly fees; longer time slots for complex care; co-located specialist mental health care teams; formal and informal networks; multidisciplinary assessments, meetings and training; awareness of mental health care resources; and good communication between practitioners, including follow-up information after referrals.
The main barriers to mental health management were: poor access to specialist resources; lack of mental health workers; and limited support and communication across the health care system, particularly between GPs and psychiatrists or psychologists.
GPs felt helpless and isolated when patients’ mental disorders were beyond their ability to treat, and emergency departments were the only solution.
Despite the associated challenges, GPs in this study found management of mental health problems in their practices very rewarding. However, it should be noted that this study population was over-represented by GPs with a keen interest in mental health. Among this highly motivated group, some had also been trained in psychotherapy, yet the time constraints in general practice precluded their ability to use it, thereby necessitating specialist referral.
Therefore, although continuing education and multidisciplinary case discussion enhanced GPs’ skills in mental health management, additional strategies, such as longer consultations and the ‘one-problem-per-visit’ rule, may give them more opportunities to employ advanced skills in management of patients with mental health problems.
• Petra Bywood is Research Manager, Primary Health Care Research & Information Service (PHC RIS)
Fleury, M-L., Imboua, A., Aubė, D., Farand, L. and Lambert, Y. (2012). General practitioners’ management of mental disorders: A rewarding practice with considerable obstacles. BMC Family Practice, 13:19.
This article, which can be accessed at http://www.ncbi.nlm.nih.gov/pubmed/22423592?dopt=Abstract features in the 29 March 2012 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php.
The eBulletin is designed to inform readers of recently published articles and reports, news items, media releases, upcoming conferences and courses, research grants, scholarships and fellowships, PHC RIS products and services and relevant websites in the primary health care field. Those interested in receiving the weekly eBulletin are invited to subscribe to the free service at http://www.phcris.org.au/mailinglists/index.php
Previous PHC RIS columns at Croakey