Skip to main content Accessibility help
×
Home

An analysis of 100 referrals for depression from primary care to an adult mental health service

  • C. Rogers (a1), S. Heatherington (a1), M. Carroll (a1), M. Leonard (a1) (a2), W. Cullen (a2) and D. Meagher (a1) (a2)...

Abstract

Objectives

Improving the interface between primary care and mental health services is a key target in current healthcare policy in Ireland. This study examines the content of referrals from primary care to a community mental health service for apparent depression.

Method

We retrospectively reviewed the clinical records of 100 patients with depression who consecutively attended a specialist mental health service in Ireland's midwest region. Records were reviewed for demographic and clinical information provided by the doctor at the time of referral, subsequent service engagement, diagnosis and treatment initiated.

Results

There was considerable variation in the content and presentation of information contained in referral letters. Eleven per cent used structured HSE mental health referral forms. Seventy-six per cent of referrals contained clear information regarding name, address, symptoms and treatment previously initiated. Specifically, low mood, biological symptoms of depression and illness severity were documented in 43%, 34% and 27%, respectively. Suicide risk was documented in 20%. More detail was significantly associated with more severe illness. At initial specialist assessment, 71% had commenced antidepressant treatment, with 11% having received an adequate trial of a first antidepressant and 3% an adequate trial of two antidepressants. Two-thirds were diagnosed with mild/moderate depression. Initiation of antidepressant treatment was linked to subsequent diagnosis of depressive illness by mental health services (p < 0.001).

Conclusions

Our findings indicate variable referral practices from general practice to mental health in our region. Most referrals were for mild to moderate depression. Poor access to psychological services locally may be a key factor in this phenomenon.

Copyright

Corresponding author

Address for correspondence: Professor D. Meagher, Room 01-017, Graduate Entry Medical School, University of Limerick, Ireland. Email david.meagher@ul.ie

References

Hide All
Age Concern (2008). Undiagnosed, Untreated, at Risk. The Experiences of Older People with Depression. Age Concern: London.
Akbari, A, Mayhew, A, Al Alawi, MA, Grimshaw, J, Winkens, R, Glidewell, E, Pritchard, C, Thomas, R, Fraser, C (2008). Interventions to improve outpatient referrals from primary care to secondary care. Cochrane Database of Systematic Reviews 8, CD005471, doi: 10.1002/14651858.CD005471.pub2.
Album, D, Westin, S (2007). Do diseases have a prestige hierarchy? A survey amongst physicians and medical students. Social Science & Medicine 66, 182188.
Arroll, B, Khin, N, Kerse, N (2003). Screening for depression in primary care with two verbally asked questions: cross sectional study. British Medical Journal 327, 11441146.
Banks, R, Gask, L (2008). It's time to talk: rekindling the relationship with primary care. Advances in Psychiatric Treatments 14, 8485.
Barth, J, Schumacher, M, Herrmann-Lingen, C (2004). Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosomatic Medicine 66, 802813.
Burbach, F (1997). GP referral letters to a community mental health team: an analysis of the quality and quantity of information. International Journal of Health Care Quality Association 10, 6772.
Burns, T (2004). Community Mental Health Teams. A Guide to Current Practices. Oxford University Press: Oxford.
Campbell, C, Parsons, B, Loane, R (2008). Analysis of referral letters to a department of old age psychiatry. Irish Journal of Psychological Medicine 25, 2428.
Chew-Graham, CA, Slade, M, Montana, C, Stewart, M, Gask, L (2007). A qualitative study of referral to community mental health teams in the UK: exploring the rhetoric and the reality. BMC Health Services Research 7, 117.
Cohen, A (2008). The primary care management of anxiety and depression: a GP's perspective. Advances in Psychiatric Treatments 14, 98105.
Copty, M (2004). Mental Health in Primary Care. ICGP/SWAHB: Dublin.
Copty, M, Whitford, D (2005). Mental health in general practice: assessment of current state and future needs. Irish Journal of Psychological Medicine 22, 8386.
Crawford, P, Carr, J, Knight, A, Chambers, K, Nolan, P (2001). The value of community mental health nurses based in primary care teams: ‘switching the light on in a cellar’. Journal of Psychiatric and Mental Health Nursing 8, 213220.
Department of Health and Children (2001). Primary Care: A New Direction. Quality and Fairness – A Health System For You. The Government Stationary Office: Dublin.
Department of Health and Children (2006). ‘A Vision for Change’. Report of the Expert Group on Mental Health Policy. The Government Stationary Office: Dublin.
Dowrick, C, Leydon, GM, McBride, A, Howe, A, Burgess, H, Clarke, P, Maisey, S, Kendrick, C (2009). Patients’ and doctors’ views on depression severity questionnaires incentivised in UK quality and outcomes framework: qualitative study. British Medical Journal 338, b663.
Evans, A (1993). A study of the referral decision in general practice. Family Practice 10, 104110.
Gask, L, Lester, H (2008). Working together. Invited commentray on ‘The primary care management of anxiety and depression’. Advances in Psychiatric Treatments 14, 106108.
Gilbody, S, Whitty, P, Grimshaw, J, Thomas, R (2003). Educational and organizational interventions to improve the management of depression in primary care: a systematic review. The Journal of the American Medical Association 289, 31453151.
Health Information and Quality Authority (2010). Standardising patient referral information: a draft national template for consultation. 14 December 2010.
Hegarty, K, Gunn, J, Blashki, G, Griffiths, F, Dowell, T, Kendrick, T (2009). How could depression guidelines be made more relevant and applicable to primary care. The British Journal of General Practice 59, e149e156.
Hilton, C, Bajal, P, Hagger, M, Taha, S, Warner, J (2008). What should prompt an urgent referral to a community mental health team? Mental Health in Family Medicine 5, 197201.
Hull, SA, Jones, C, Tissier, JM, Eldridge, S, Maclaren, D (2002). Relationship style between GPs and community mental health teams affects referral rates. The British Journal of General Practice 52, 101107.
Irish College of General Practitioners (2006). Guidelines for the Management of Depression and Anxiety Disorders in Primary Care. Health Services Executive. Kildare St., Dublin.
Kendrick, T, Dowrick, C, McBride, A, Howe, A, Clarke, C, Maisey, S, Moore, M, Smith, PW (2009). Management of depression in UK general practice in relation to scores on depression severity questionnaires: analysis of medical record data. British Medical Journal 338, b750.
Kendrick, T, Simons, L, Mynors-Wallis, L, Gray, A, Lathlean, J, Pickering, R, Harris, S, Rivero-Arias, O, Gerard, K, Thompson, C (2006). Cost-effectiveness of referral for generic care or problem-solving treatment from community mental health nurses, compared with usual general practitioner care for common mental disorders: randomised controlled trial. British Journal of Psychiatry 189, 5059.
Kessler, D, Lloyd, K, Lewis, G, Gray, DP (1999). Cross sectional study of symptom attribution and recognition of depression and anxiety in primary care. British Medical Journal 318, 436440.
Kroenke, K, Spitzer, RL, Williams, JB (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606613.
Layard, R, Clark, D, Knapp, M, Mayraz, G (2006). Implementing NICE guidelines for depression and anxiety. A cost-benefit analysis. Paper for the Mental Health Policy Group. http://cep.lse.ac.uk/layard. Accessed 3rd July 2011.
Lester, H, Howe, A (2008). Depression in primary care: three key challenges. Postgraduate Medical Journal 84, 545548. doi:10.1136/pgmj.2008.068387.
Meagher, D, O'Brien, S, Pullela, A, Oshun, A, Brosnan, P (2009). Multidisciplinary activities in a community mental health service: relationship to health of the nation outcome scale scores and diagnosis. Psychological Bulletin 33, 273275.
National Institute for Clinical Excellence (2004). Depression: Management of Depression in Primary and Secondary Care. Clinical Guideline 23. NICE: London. http://www.nice.org.uk/pdf/CG023quickrefguide.pdf.
Prins, MA, Verhaal, PF, Smolders, M, Laurant, MG, van der Meer, K, Spreeuwenberg, P, van Marwijk, HW, Penninx, BW, Bensing, JM (2010). Patient factors associated with guideline-concordant treatment of anxiety and depression in primary care. Journal of General Internal Medicine 25, 648655.
Raju, B, Meagher, D (2005). Patient-controlled benzodiazepine dose reduction in a community mental health service. Irish Journal of Psychological Medicine 22, 4245.
Ross, S, Moffat, K, Mcconnachie, A, Gordon, J, Wilson, P (1999). Sex and attitude: a randomized vignette study of the management of depression by general practitioners. The British Journal of General Practice 49, 1721.
Shaw, I, Clegg Smith, KM, Middleton, H, Woodward, L (2005). A letter of consequence: referral letters from general practitioners to secondary mental health services. Qualitative Health Research 15, 116128.
Slade, M, Cahill, S, Kelsey, W, Leese, M, Powell, R (2002). Threshold 4: an evaluation of the threshold assessment grid as an aid to mental health referrals. Primary Care Mental Health 1, 4554.
Slade, M, Gask, L, Leese, M, McCrone, P, Montana, C, Powell, R, Stewart, M, Chew-Graham, C (2008). Failure to improve appropriateness of referrals to adult community mental health services – lessons from a multi-site cluster randomized controlled trial. Family Practice 25, 181190.
Verhaak, PF, van der Lisdonk, EH, Bor, JH, Hutschemaekers, GJ (2000). GPs’ referral to mental health care during the past 25 years. The British Journal of General Practice 50, 307308.
Williams, JW Jr, Katon, W, Lin, EH, Nöel, PH, Worchel, J, Cornell, J, Harpole, L, Fultz, BA, Hunkeler, E, Mika, VS, Unützer, J; IMPACT Investigators (2004). The effectiveness of depression care management on diabetes-related outcomes in older people. Annals of Internal Medicine 140, 10151024.
World Health Organization (1992). Mental and Behavioral Disorders (F00-F99). The International Classification of Diseases, 10th Rev: ICD-10. World Health Organization: Geneva.
World Health Organization (2001). World Health Report 2001: Mental Health: New Understanding, New Hope. World Health Organization: Geneva, Switzerland.

Keywords

An analysis of 100 referrals for depression from primary care to an adult mental health service

  • C. Rogers (a1), S. Heatherington (a1), M. Carroll (a1), M. Leonard (a1) (a2), W. Cullen (a2) and D. Meagher (a1) (a2)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed