Managing common mental health disorders in primary care: conceptual models and evidence base

Abstract

The use of conceptual models can help to bridge the gap between research findings and policy development, illustrated here by the complex area of primary care mental health servicesThe trend is towards greater use of research evidence (especially systematic reviews) in the development of health policy. However, systematic reviews have traditionally been designed for clinical decision making, and linking such evidence to the broader perspectives and goals of policy makers is complex.1 In such cases, conceptual models are often useful. Models are abstract representations of complex areas-"inventions of the human mind to place facts, events and theories in an orderly manner." 2 We will attempt to illustrate the way in which such models can assist in the application of evidence from systematic reviews to policy, using the example of mental health care in primary care.

Collaborative care for depression in UK primary care: a randomized controlled trial

“…Only one in four depressed people receive effective pharmacological treatment and less than 10 % a talking therapy (Singleton et al 2001). Bower & Gilbody (2005) have identified four types of organizational strategies to improve this situation : training and the use of guidelines for general practitioners and primary care staff ; 'consultation liaison ', whereby specialist mental health practitioners advise on the care of individual patients in primary care ; 'collaborative care ', an enhanced form of consultation liaison which also includes a case manager to deliver care and liaise between GP, specialist and patient ; and 'replacement referral ' which refers to the deployment of specialists in secondary or primary care to whom GPs can refer.…”

Treatment dropout at a secondary mental health service

“…The west region referral center (Centro Regional de Referência em Saúde Mental -Oeste), which will be described in the present study, holds learning and clinical practice activities of the Psychiatry and Medical Treatment dropout at a mental health service -Ribeiro et al other diagnoses. 18,19 The 57 independent variables were first analyzed in an exploratory manner. A bivariate analysis was used to investigate possible associations between the independent variables and the outcome of interest (treatment status).…”

Teamwork Within Mental Health Services in Ireland: Resource Paper

“…51 Provision of information or more intensive practicebased education and treatment seminars on the identification of mental health presentations, 52 along with agreed referral guidelines (see Section 5.1.1), may also increase primary care capacity. In making better use of available capacity, the 'Stepped' care approach can increase throughput and the appropriateness of service provision.…”

“…50 To improve primary care service capacity, various models of primary and secondary care liaison have been proposed, none of which appear to be more effective than others. 51 However, it is anticipated that the consultationliaison model will be rolled out, 4 whereby secondary care mental health team members will enter into ongoing educational and supportive relationships with primary care clinicians. In allowing cases to be discussed without formal (onward) referral by primary care, regular on-site liaison has the potential to reduce the number of inappropriate referrals to secondary services and to develop capacity in primary care.…”