Evaluating a primary care counselling service: outcomes and issues

Abstract

Mental health issues are the third most common reason for consulting a general practitioner (GP), after respiratory disorders and cardiovascular disorders (Department of Health, 1991; Hemmings, 2000). A quarter of routine GP consultations relate to people with a mental health problem, most commonly depression and anxiety. It has been estimated that each year, one in 15 women and one in 30 men will be affected by depression, and every GP will see between 60 and 100 people with depression (Department of Health, 1999). A survey of 325 GPs conducted by the Mental Health After Care Association in 1999 found that 30% of their time, roughly 1.5 days a week, is spent working on patients' mental health problems, particularly relating to anxiety and depression (Davidson, 2000).The direct costs of treating depression in the UK in the early 1990s was estimated to be around £400 million a year and the indirect costs, including mortality costs and lost productivity was £3000 million (Kendrick, 2002). Standard two of the National Service Framework for mental health (Department of Health, 1999) states that: 'Any service user who contacts their primary health care team with a common mental health problem should: 1) have their mental health needs identified and assessed; 2) be offered effective treatments, including referral to specialist services for further assessment, treatment and care if they require it' (p. 28). To achieve this, primary

Effectiveness of cognitive-behavioural, person-centred, and psychodynamic therapies in UK primary-care routine practice: replication in a larger sample

“…Incomplete data are common in routine practice settings (Stiles et al 2003 ;Gilbert et al 2005 ;Greasley & Small, 2005), and we emphasize that our conclusions are limited to patients who completed post-treatment forms. Among patients who do receive treatment, those who complete post-treatment measures are more likely to have agreed with their therapist about when treatment should end ) and more likely to have improved more during treatment (Stiles et al 2003) than are patients who fail to complete them.…”

Counselling in primary care: A study of the psychological impact and cost benefits for four chronic conditions

“…Moreover, that evidence which exists is largely inconclusive or conflicting, and restricted in focus (Vedsted & Christensen, 2005). For instance, the lack of accord between existing research findings on psychological outcomes can be illustrated by the following examples: Ward et al (2000), The NHS Centre for Reviews and Dissemination (2001), Greasley and Small (2005) and Bower et al (2003) all found that counselling was more effective than standard GP care in the short term for patients with mental health problems, although the benefits had typically disappeared after twelve months. On the other hand, Beecham (2003a, 2003b) found very little evidence of improved outcomes for patients suffering from chronic depression or other mental health problems, while Baker et al (1998) …”

“…One approach has been to focus on those patients who make heavy claims on GP time, such as frequent attenders (FAs) and those patients for whom the primary problems are psychological in origin (e.g. Greasley & Small, 2005). A considerable amount of research attention has been particularly directed to FAs, whose problems are often complex, with high levels of physical, psychological and social morbidity (Vedsted & Christensen, 2005).…”

Primary Health Care Service Use Among Women Who Have Recently Left an Abusive Partner: Income and Racialization, Unmet Need, Fits of Services, and Health

“…Furthermore, both unmet need for and fit of primary medical services in a PHC system, such as those provided by a family doctor, general practice physician, or nurse practitioner, have been associated with early detection of illness and disease, resulting in better mental and physical health outcomes (Bindman, Grumbach, Osmond, Vranzian, & Stewart, 1996;Shi, 1994;Shi et al, 2004;Vogel & Ackerman, 1998). Moreover, patients who access mental health services in PHC settings, such as those provided by counselors, social workers, psychologists, and psychiatric nurses, without the requirement of a referral, report significant improvements in depressive symptoms, anxiety, self-esteem, and quality of life over time (Baker et al, 2002;Greasley & Small, 2005;Nettleton et al, 2000). Few Canadian researchers, however, have examined the impact of either unmet need or fit of PHC services on the mental and physical health of Canadians, including women who have experienced IPV.…”