Abstract
BackgroundMental illness acts as a barrier to accessing and obtaining effective medical care. It has been shown that out of hours services are an important first stop for emergency care for people experiencing mental health difficulties. However, little is in fact known about the use of out of hours general practice services by people experiencing mental health difficulties.AimTo establish the number and range of consultations that have a primary or related mental health issue attending general practitioner (GP) out of hours and to document adherence to their follow-up care referral.Design and settingDescriptive study in one large out of hours primary care service in the South East of Ireland (Caredoc).MethodsAn anonymous extraction of retrospective data from 1 year of the out of hours’ electronic database was undertaken. Patients who attended the out of hours with a possible mental health issue and were referred to the psychiatric services or back to their own GP, were tracked via phone follow-up with hospitals and GPs over 6 months to establish if they attended for the recommend follow-up care.ResultsOver a 1 year period, there were 3844 out of hours presentations with a mental health component. Overall, 9.3% were referred by the out of hours GP for follow-up to a hospital emergency department (ED) or were advised to attend their own GP. A total of 104 patients who were advised to attend their GP or ED following their consultation with the out of hours GP were tracked. Twenty-seven patients were referred back to their GP of which the follow-up call to the GP revealed that 44.5% did not attend. Seventy-seven patients were referred to the hospital services, of whom 37.7% did not attend.ConclusionsThere are significant challenges at the interface of primary care and secondary mental health services in Ireland. As expounded by the WHO and WONCA, in order to be effective and efficient, care for mental health must be coordinated with services at different levels of care complemented by the broader health system.
Highlights
Mental illness acts as a barrier to accessing and obtaining effective medical care
Twenty-seven patients were referred back to their general practitioner (GP) of which the follow-up call to the GP revealed that 44.5% did not attend
As expounded by the WHO and WONCA, in order to be effective and efficient, care for mental health must be coordinated with services at different levels of care complemented by the broader health system
Summary
Mental illness acts as a barrier to accessing and obtaining effective medical care. Research suggests that morbidity and mortality rates are higher among individuals with serious mental health issues [4,5,6,7,8,9,10,11] For those with a diagnosed mental illness, structural and systemic health disparities impact on access to and utilisation of health care [5]. There is unanimous consensus from the international literature that general practice has a central role in the provision of medical treatment and preventative health care to people with a severe mental illness [12,13,14,15]. Identifying and providing the most suitable treatment for people with common mental health problems can be a difficult and complex process for health [17]
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