Essential characteristics and components of a primary care mental health service
SUMMARY Mental disorders are a significant disease burden and often interwoven with other chronic diseases., In recent years there has been a shift to ensuring more and more mental health care provision through primary care with the emphasis on managing mental health needs and delivering as much mental health care as possible within the primary care setting. To explore healthcare practitioners’ views of mental health care provision in primary care a qualitative study through semi-structured, telephone interviews using purposive sampling and followed by a framework thematic analysis was undertaken.
Data were collected between February 2011 and April 2011. 28 healthcare practitioners including General Practitioners (GPs), Mental Health Practitioners working in primary care, Specialist Nurses and a Mental Health Team Manager took part. Our findings were: that services were overstretched in some areas due to lack of resources; that there are gaps in provision – particularly for patients with dual diagnosis and complex mental health problems who are often ‘bounced back’ from specialist or secondary care services; there is a clear lack of time for GPs to manage mental health issues with patients; there is a an appetite for Mental Health Practitioners to be embedded in surgeries (reported to increases communication and reduces waiting times); there is a degree of ‘Over triage’ and difficulties in GPs referring directly to therapies and psychiatrists; practitioners generally felt adequately qualified, though many felt specific skills training was lacking to adequately perform their roles; that some GPs, particularly those with Mental Health Practitioners and Counsellors in-house, and good communications with Community Mental Health Teams and Psychiatrists, felt well supported; that a change of focus is needed from service driven to a truly person centred approach.
There is a need to raise the profile of mental health, both in the general public’s awareness of mental wellbeing and through NHS prioritisation. There are well supported GP practices across North Wales but these appear to be the minority and should be considered the standard model to be adopted throughout Wales, the UK and further afield. This study shows that primary care mental health provision requires 1) adequate resources and time to provide quality care; 2) access to a range of different therapies and services; 3) well trained mental health practitioners who are equipped to provide a wide range of quality interventions in primary care to suit the needs of their patients; 4) robust secondary care mental health support for primary care practitioners, including mental health professionals who work within GP surgeries, 5) adequate provision of counsellors/therapists for the size of the practice population, and 6) direct access to psychiatrists and therapies when required.