Primary Care Mental Health Teams Research Articles

Making Sense of the Urgent GP Referrals; Audit Into How Many Are Actually Urgent?

AimsThe trust policy dictates that all urgent GP referrals should be contacted within 48 hours by the duty team. The duty team carries out a telephone screening assessment and offers the patients who are deemed to be urgent, a face-to-face assessment. Those who are not assessed to be urgent are signposted to the right service.MethodsAll the urgent GP referrals of the month of July 2021 were followed up retrospectively and the outcome was recorded to assess the influx and outcome of urgent referrals from primary care. The urgent referrals from all other routes such as Psychiatric Liaison, and Social Services, Police etc were not included in the data.ResultsA total of 124 urgent referrals were received in the month of July 2021. Only 13 out the 124 were deemed urgent following the telephone assessment and they were offered a face-to-face assessment. Fifty three patients were referred to primary care mental health team, 24 were referred to the secondary community mental health, 20 were referred to the older adults team and 10 were discharged back to the GP following. Out of the 13 who were assessed by the duty team, 6 patients were referred to primary care mental health team and 6 were referred to the secondary community mental health team. The urgent referrals came from 20 GP surgeries that cover a wide area of the rural and urban communities and the surgeries with most urgent referrals were highlightedConclusionTrying to work on improving the quality of urgent referrals, the team tried to analyse the results, which proved to be complicated. The efforts to standardise the referral process has depended mainly on the degree of awareness of the GPs about the way the mental health service operates considering there is a percentage of locum GPs who might not be fully aware of how mental health service works.The recommendation of the audit is to arrange visits to the GP surgeries to work on raising awareness among GPs about the referral system to the Mental Health team. It is also recommended that the GPs should be able to complete a brief risk assessment to justify why the referred patient needs to be reviewed urgently instead of on routine basis.

Service evaluation of primary care mental health support services in north Wales

AimsBringing specialist psychiatrist into PCMHTUndertaking initial assessments for people Referred by G.P'sWorking According to the principle of “Prescribing Interventions”Decrease number of assessments carried out within secondary CareMethodCounty of Wrexham is situated between the lower Dee Valley and the Welsh mountains. It is the largest town in North Wales (140,000)Since 2013, the total new patient referrals to be seen by Wrexham county consultant psychiatrists has consistently risenThis issue has been dealt with in different ways across North Wales and indeed the whole of WalesFollowing a review of services in Wrexham during 2017, it was identified that there was an opportunity to pilot a new model which would allocate a designated Consultant to the local Primary Care Mental Health Team (PCMHT)The Consultant would work entirely within Part 1 of the Mental Health Measure and would offer specialist opinions to Tier 1 ServicesResultPCMHT team members are maintaining open cases for a significant amount of time rather than the 8–10 sessions that was originally predicted during the implementation of the Mental Health MeasuresIn order to sustain the service, the minimum number of direct clinical patient contact sessions to be offered by the psychiatrist was up to 4 a week.During the review period, total number of clinics offered were 51 and a total of 139 patients were offered appointmentsConsultants in secondary care covering the same area received exactly 100 less referrals in the first 6 months of the pilotMain source of referrals to the Tier 1 Consultant came from G.P.'s and the local PCMHT itselfConclusionPilot demonstrated that bringing specialist consultant psychiatrist dedicated to the PCMHT improved the care offered to patients referred by G.P'sScope of PCMHT needs to extend in order to absorb mild to moderate mental illness and thus avoid patients going into secondary careThis model should be supported, and further resources should be inputted into PCMHTWe should move from a categorical diagnostic referral system to a needs-based intervention where only the most complex cases requiring lengthy interventions shall progress to secondary careRisk should not be classed as criteria to move patients into secondary care and PCMHT should be able to absorb moderately risky cases

Predictors of change in housing status over 12months among individuals using emergency shelters, temporary housing or permanent housing in Quebec, Canada.

Homelessness is an ongoing societal and public health problem in Canada and other countries. Housing services help homeless individuals along the transition towards stable housing, yet few studies have assessed factors that predict change in individual housing trajectories. This study identified predictors of change in housing status over 12months for a sample of 270 currently or formerly homeless individuals using emergency shelters, temporary housing (TH) or permanent housing (PH) resources in Quebec. Participants recruited from 27 community or public organisations were interviewed between January and September 2017, and again 12months later. Sociodemographic variables, housing history, health conditions, service use and client satisfaction were measured. Directors and programme coordinators from the selected organisations also completed a baseline questionnaire measuring strictness in residential codes of living/conduct, interorganisational collaboration and overall budget. Independent variables were organised into predisposing, enabling and needs factors, based on the Gelberg-Andersen Behavioral Model. Multilevel logistic regressions were used to test associations with the dependent variable: change in housing status over 12months, whether positive (e.g. shelter to TH) or negative (e.g. PH to shelter). Predictors of positive change in housing status were as follows: residing in PH, being female, having children (predisposing factors); having consulted a psychologist, higher frequency in use of public ambulatory services (enabling factors); and not having physical illnesses (needs factor). The findings support strategies for helping this clientele obtain and maintain stable housing. They include deploying case managers to promote access to public ambulatory services, mainly among men or individuals without children who are less likely to seek help; greater use of primary care mental health teams; the establishment of more suitable housing for accommodating physical health problems; and reinforcing access to subsidised PH programmes.

Clinical judgement, case complexity and symptom scores as predictors of outcome in depression: an exploratory analysis

BackgroundClinical guidelines for depression in adults recommend the use of outcome measures and stepped care models in routine care. Such measures are based on symptom severity, but response to treatment is likely to also be influenced by personal and contextual factors. This observational study of a routine clinical sample sought to examine the extent to which “symptom severity measures” and “complexity measures” assess different aspects of patient experience, and how they might relate to clinical outcomes, including disengagement from treatment.MethodsSubjects with symptoms of depression (with or without comorbid anxiety) were recruited from people referred to an established Primary Care Mental Health Team using a stepped care model. Each participant completed three baseline symptom measures (the Personal Health Questionnaire (PHQ), Generalised Anxiety Disorder questionnaire (GAD) and Clinical Outcomes in Routine Evaluation (CORE-10)), and two assessments of “case complexity” (the Minnesota-Edinburgh Complexity Assessment Measure (MECAM) and a local complexity assessment). Clinician perception of likely completion of treatment and patient recovery was also assessed. Outcome measures were drop out and clinical improvement on the PHQ.Results298 subjects were recruited to the study, of whom 258 had a sufficient dataset available for analysis. Data showed that the three measures of symptom severity used in this study (PHQ, GAD and CORE-10) seemed to be measuring distinct characteristics from those associated with the measures of case complexity (MECAM, previous and current problem count). Higher symptom severity scores were correlated with improved outcomes at the end of treatment, but there was no association between outcome and complexity measures. Clinicians could predict participant drop-out from care with some accuracy, but had no ability to predict outcome from treatment.ConclusionsThese results highlight the extent to which drop-out complicates recovery from depression with or without anxiety in real-world settings, and the need to consider other factors beyond symptom severity in planning care. The findings are discussed in relation to a growing body of literature investigating prognostic indicators in the context of models of collaborative care for depression.

Group CBT for mild to moderate depression and anxiety: an evaluation of patient satisfaction within a primary care mental health team

Abstract In the UK there has been a drive towards facilitating swift access to psychological therapies. Groups are an efficient way to provide psychological interventions to a wide range of people and are recommended treatments for mild depression and anxiety, presentations commonly seen in primary care mental health teams. Group cognitive behavioural therapy (CBT) has been shown to be clinically effective, but less is known about the acceptability of groups to patients. This study evaluated patient satisfaction with CBT groups running within a primary care mental health team in Scotland. Data from a routinely administered patient satisfaction questionnaire were collected. Likert-scale responses were analysed via frequencies and percentages, and free text responses were analysed via thematic analysis. Among those who completed a group, overall satisfaction was high. The qualitative analysis revealed that for many a group environment was therapeutic in itself, and the intervention provided service users with a range of skills with which to tackle their difficulties. However, others indicated that a group environment was unsuitable for their needs, and perceptions around the accessibility and relevance of group content were mixed. Indeed, drop-out rates were high, and perceptions of groups among those who did not attend the final session are not included in this analysis. Group dynamics may be both a facilitator of and a barrier to therapeutic benefit, depending on individual factors. Future studies could evaluate satisfaction among service users who drop out of interventions in order to inform future service delivery. Key learning aims (1) To understand the utility of delivering CBT in a group format for mild to moderate depression and anxiety. (2) To understand service users’ perceptions regarding group CBT interventions via a mixed method inquiry. (3) To reflect on how group dynamics within group CBT may be both a facilitator of and a barrier to therapeutic benefit.

The value of mental health nurses working in primary care mental health teams

New roles have made it more difficult for nurses to validate their unique contribution, argue Carol Richards and colleagues

An exploration of why people drop out from using a primary care mental health service

This study outlines a survey of people who had dropped out from using a primary care mental health team (PCMHT). It aimed to find out their reasons for disengaging and ways to overcome any barriers identified.

Call-back: Improving access to a multilevel, multi-purpose primary care mental health team

Call-back: Improving access to a multilevel, multi-purpose primary care mental health team

Perceived barriers preventing older adults accessing primary care mental health teams

This study aimed to identify and explore the barriers to older adults accessing a primary care mental health team. We discuss the implications of our findings and suggest service improvements in order to address identified barriers.

Www.glasgowsteps.com: A low-intensity approach to common mental health problems

This paper looks atwww.glasgowsteps.com, one of the low intensity interventions offered by the STEPS primary care mental health team. The site is easy to navigate and offers information about common mental health problems, interactive selfassessment, self-help and free video, audio and written downloads.

Primary care mental health teams: Where are all the older people?

We report a referral audit of older people into primary care mental health teams in NHS Greater Glasgow. Although they comprise 16 per cent of the local population, referral rates for older people were 3.21 per cent. We discuss the implications of these findings, and potential solutions.

Teamwork in primary care mental health: a policy analysis

This paper reports a policy analysis conducted to examine the potential impact of recent mental health policy on team working in Primary Care Mental Health in England. An analysis of relevant policy documents was conducted. From an original selection of 49 documents, 15, which had significant implications for Primary Care Mental Health Teams, were analysed thematically. There were no clear guidelines or objectives for Primary Care Mental Health Teams evident from the policy analysis. Collaborative working was advocated, yet other elements in the policies were likely to prevent this occurring. There was a lack of clarity concerning the role and function of new professions within Primary Care Mental Health Teams, adding further uncertainty to an already confused situation. This uncertainty has the potential to reinforce professional barriers and increase the current difficulties with team working. IMPLICATIONS TO NURSING MANAGERS: An analysis of recent policy contributes to our understanding of the context of care. The lack of clarity in current health policy presents a significant challenge for those managing primary care mental health teams. Team working is likely to improve if targets, processes and responsibilities are made clearer.

STEPS: Going beyond the tip of the iceberg. A multi‐level, multipurpose approach to common mental health problems

STEPS is a primary care mental health team that has attempted to develop a very high volume multi‐level, multi‐purpose service for those with mild to moderate problems. The service attempts to overcome many of the limitations of more traditional services. This paper describes the services contained within the six level model.

‘Laff Yer Heid Aff’: The role of comedy inincreasing public awareness of common mental health problems

STEPS, a Glasgow primary care mental health team, has supported a comedy event held as part of the Scottish Mental Health Film and Arts Festival. The comedy event, which took place on World Mental Health Day (10 October 2007) marked the launch of a new STEPS mental health promotion comedy DVD.

Primhe: Primary Care Mental Health & Education

AbstractBenefits of mindfulness‐based stress reduction groups to primary care mental healthIn this article, Jason Randall provides a brief description of meditation, mindfulness, and the mindfulness‐based stress reduction (MBSR) group developed by Dr Jon Kabat‐Zinn. He discusses the benefits of this group to the primary care mental health team (PCMHT) as well as some of the obstacles to its implementation.Mental Health in the Mainstream: a new approach to mental healthHere, Jennifer Rankin, author of the Institute for Public Policy Research (ippr) report Mental Health in the Mainstream, outlines the main recommendations of the report and discusses the changes that are needed for these recommendations to be implemented. Copyright © 2007 Wiley Interface Ltd

Process and Outcome of a Non-Guided Self-Help Manual for Anxiety and Depression in Primary Care: A Pilot Study

Self-help interventions in mental health are increasingly seen as one way of overcoming problems with access to psychological therapy, but there is insufficient evidence of effectiveness in routine care settings. This paper investigates the process and outcome of a non-guided self-help manual for anxiety and depression compared to a waiting list control in a primary care setting. Patients with mild to moderate mental health problems were recruited from routine GP referrals to the local Primary Care Mental Health Team. Thirty patients were randomly assigned to either non-guided self-help or a waiting list control group. Patients completed outcome measures at baseline, 6 weeks and 12 weeks. Intention to treat analysis found no significant differences between the two groups on measures of anxiety or depression at 12 weeks. Between 40% to 50% of patients in both groups were no longer clinical cases at the end of the trial. However, there was a high level of satisfaction with the self-help manual. Within the limitations of the small sample size, the study does not support the hypothesis that non-guided self-help is superior to waiting list control in the treatment of anxiety and/or depression in primary care.