The Role of Primary Care in Service Provision for People with Severe Mental Illness in the United Kingdom

Abstract

BackgroundSevere mental illness is a serious and potentially life changing set of conditions. This paper describes and analyses patient characteristics and service usage over one year of a representative cohort of people with a diagnosis of severe mental illness across England, including contacts with primary and secondary care and continuity of care.Methods and FindingsData were collected from primary care patient notes (n = 1150) by trained nurses from 64 practices in England, covering all service contacts from 1st April 2008 to 31st March 2009. The estimated national rate of patients seen only in primary care in the period was 31.1% (95% C.I. 27.2% to 35.3%) and the rates of schizophrenia and bipolar disorder were 56.8% (95% C.I. 52.3% to 61.2%) and 37.9% (95% C.I. 33.7% to 42.2%). In total, patients had 7,961 consultations within primary care and 1,993 contacts with mental health services (20% of the total). Unemployed individuals diagnosed more recently were more likely to have contact with secondary care. Of those seen in secondary care, 61% had at most two secondary care contacts in the period. Median annual consultation rates with GPs were lower than have been reported for previous years and were only slightly above the general population. Relational continuity in primary care was poor for 21% of patients (Modified Modified Continuity Index = <0.5), and for almost a third of new referrals to mental health services the primary care record contained no information on the referral outcome.ConclusionsPrimary care is centrally involved in the care of people with serious mental illness, but primary care and cross-boundary continuity is poor for a substantial proportion. Research is needed to determine the impact of poor continuity on patient outcomes, and above all, the impact of new collaborative ways of working at the primary/secondary care interface.

Improving community health networks for people with severe mental illness: a case study investigation

“…Research has found a high proportion of cases of SMI are supported solely by a GP (31%) or with minimal secondary care input. 15 This was not a new finding. A review of the role of family practitioners reported about one-quarter of people with schizophrenia saw only their GP 16 and only 64% of sampled service users were in contact with a psychiatrist.…”

Inpatients´ utilization of GP and psychiatric outpatient care. A comparison of a central-institution versus a local-institution based system of psychiatry. A case-register study

“…Recent studies suggest that for patients with severe conditions, cross boundary continuity are poor, and many are not seen in specialized care (7,8).…”

The James Mackenzie Lecture 2012: Bothering about Billy

“…20 Now it's closer to three, only just very slightly more than the general population. 18 I don't think this reflects a reduction in need but rather problems with access.…”

“…Over 70% of patients are now largely managed by primary care, making it very much our business. 18 Most service users also describe primary care as the cornerstone of their care. 19 People want an advocate and system navigator at times of crisis.…”

“…Only 18% of those nurses have received any sort of mental health training. 18 So should we train more of our practice nurses in mental health issues and then encourage them to use these and their excellent physical healthcare skills in mental health reviews?…”