BackgroundShared understanding between GPs and hospital specialists concerning when patients need specialised mental health care is important to ensure patients receive appropriate care. The large amount of rejected referrals often indicates a lack of such shared understanding.AimTo explore how patient representatives, GPs, and mental health specialists understand ‘need for specialised mental health care’, meaning that primary care is no longer sufficient.Design & settingThis qualitative study was conducted in western Norway. The study has a service user-involved research design in which GPs and patient representatives participated in all stages of the research process.MethodSix semi-structured focus group interviews were conducted. The groups were homogenous as they included only the perspectives of either GPs, mental health specialists, or patient representatives. Data were analysed using thematic analysis.ResultsThe need for specialised mental health care was assessed using two continuums: (a) the patient’s level of functioning and symptoms; and (b) characteristics of the healthcare system and the patient’s informal support networks. Assessment along these continuums were often overruled by the evaluation of expected usefulness of specialised mental health care. In addition, all participants reported they often adapted their definition of need to fit other stakeholders’ interpretations of need.ConclusionEvaluation of need for specialised mental health care is complex and depends on several factors. This may explain some of the current challenges that exist with regard to equity and timely access to appropriate healthcare interventions.

BackgroundThe ‘discharge letter’ is the mandatory written report sent from specialists in the specialist services to general practitioners (GPs) on patient discharge. Clear recommendations from relevant stakeholders for contents of discharge letters and instruments to measure the quality of discharge letters in mental healthcare are needed. The objectives were to (1) detect which information relevant stakeholders defined as important to include in discharge letters from mental health specialist services, (2) develop a checklist to measure the quality of discharge letters and (3) test the psychometric properties of the checklist.MethodsWe used a stepwise multimethod stakeholder-centred approach. Group interviews with GPs, mental health specialists and patient representatives defined 68 information items with 10 consensus-based thematic headings relevant to include in high-quality discharge letters. Information items rated as highly important by GPs (n=50) were included in the Quality of Discharge information-Mental Health (QDis-MH) checklist. The 26-item checklist was tested by GPs (n=18) and experts in healthcare improvement or health services research (n=15). Psychometric properties were assessed using estimates of intrascale consistency and linear mixed effects models. Inter-rater and test–retest reliability were assessed using Gwet’s agreement coefficient (Gwet’s AC1) and intraclass correlation coefficients.ResultsThe QDis-MH checklist had satisfactory intrascale consistency. Inter-rater reliability was poor to moderate, and test–retest reliability was moderate. In descriptive analyses, mean checklist scores were higher in the category of discharge letters defined as ‘good’ than in ‘medium’ or ’poor’ letters, but differences did not reach statistical significance.ConclusionsGPs, mental health specialists and patient representatives defined 26 information items relevant to include in discharge letters in mental healthcare. The QDis-MH checklist is valid and feasible. However, when using the checklist, raters should be trained and the number of raters kept to a minimum due to questionable inter-rater reliability.