Ideal and Actual Referral Choices for Mental Health Problems in Primary Care

Abstract

With the increasing role of primary care in managing mental health problems there are now a number of different professionals who may deliver this service. GPs in one county were surveyed to find out which professionals they currently refer patients to with particular psychological problems, and which they would perceive to be the ideal referral choice if available. Results identified GPs’ perceptions of ideal professionals to treat each problem, their degree of consensus on this and discrepancies between ideal and actual referral choices.Overall, at least half the GPs could refer to their perceived ideal practitioner. There was greater discrepancy between actual and ideal referral choices for several problems, where 30 per cent to 50 per cent of patients were not currently being referred to the ideal choice. This may indicate shortfalls in service provision, for various practitioners, and raises questions about the effectiveness of treatment available to these patients. GPs often see patients themselves instead, or refer elsewhere, especially to CPNs who are readily available.Consensus was high for some problems, and for others was spread between four or five different practitioners. Questions arise about appropriateness of some referral choices and practitioner qualifications. The need for clearer information and referral guidelines is highlighted, and perhaps a reassessment of priorities in service provision.The case for referral guidelines has been made by ‘Treatment Choice in Psychological Therapies and Counselling – evidence-based clinical practice guideline’, Department of Health, February 2001. (www.doh.gov.uk/mentalhealth/treatmentguideline).This study reinforces this need for clear referral guidelines.