Abstract
Referring patients from specialist mental-health services (provided by multiple healthcare service providers and aimed at relieving symptoms of mental illness) to less intensive care (provided by a nurse or psychologist in cooperation with a general practitioner and aimed at improving quality of life) is feasible from the perspective of patients, service providers, and mental-health services. However, it is unclear which patients are most suitable for referral to less intensive care. In this study, we used concept mapping to identify factors that might determine whether a referral from specialist mental services to less intensive care might be successful. Participants (N = 34) were recruited from different parts of the Netherlands and included general practitioners, peer workers, community mental-health nurses, and social workers from several services who were based in different neighborhoods. The participants generated 54 statements (31 after clean-up), which were sorted into five clusters and rated on their expected ability to predict successful referral. Ordered from highest to lowest on expected predictive value, the clusters of factors were: Patient characteristics, patients’ informal support system, patients’ social situation, organization of services, and service provider related factors. The ordering was the same for all of the service providers, except that general practitioners expected the organization of services to be the most predictive. The ordering of the clusters is mostly consistent with existing knowledge about recovery during mental healthcare. In order to further improve the number of successful referrals from specialist mental-health services to less intensive care, a prospective prediction study is needed.
Highlights
Because of mental illness, some patients are seriously limited in their daily functioning, and they might need ongoing treatment for several years
A variety of healthcare service providers are involved in the treatment of patients with a severe mental illness (SMI), e.g., general practitioners, mentalhealth nurses, psychologists, psychiatrists, and social workers, and the different kinds of service providers differ in their views about which patients can successfully be referred from specialist mentalhealth services (SMHS) to less intensive treatment
Examples of less intensive treatment are mental-health services provided by a general practitioner or low intensity mental healthcare provided by a community mental-health nurse or a psychologist
Summary
Some patients are seriously limited in their daily functioning, and they might need ongoing treatment for several years. Such patients are considered to have a severe mental illness (SMI)[1], and they have traditionally been treated in specialist mentalhealth services (SMHS). SMHS provides treatment by teams of multiple healthcare service providers with different backgrounds, e.g., specialized nurses, social workers, psychiatrists, and psychologists; the treatment is typically aimed at relieving the symptoms of mental illness. A nurse provides care under direct supervision of the general practitioner Both of these less intensive treatment options are aimed at improving the patient’s quality of life more than relieving the symptoms of the mental illness. A variety of healthcare service providers are involved in the treatment of patients with a SMI, e.g., general practitioners, mentalhealth nurses, psychologists, psychiatrists, and social workers, and the different kinds of service providers differ in their views about which patients can successfully be referred from SMHS to less intensive treatment
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