Comparison of referrals from primary and secondary care to CMHT psychologists

Abstract

Objectives:To explore whether (direct) referrals from GPs to two Community Mental Health Team (CMHT) clinical psychologists differed from those received from both ‘Psychiatric’ (eg. consultant psychiatrists) and ‘Other’ sources.Method:The two psychologists retrospectively examined and coded the case files of all clients who attended them during a 12-month period. The six measures used were diagnostic prevalence and groups, co-morbidity, chronicity, previous hospital admission and CMHT contact Separate cross-tabulations and chi squared tests were conducted for the various dependent variables to profile differences across the three referral sources.Results:There was no difference in prevalence of Axis I disorders, co-morbidity and chronicity of disorders between ‘GP’ and ‘Psychiatric’ referrals to the two CMHT psychologists. However, although low in number, there were more eating and psychotic disorders among the ‘Psychiatric’ referrals, and more of these referrals had previous hospital admission and CMHT contact.Conclusions:‘GP’ referrals were similar to ‘Psychiatric’ referrals on some measures but differed on others. Hence, as to whether an ‘open access’ model of (direct) referral to CMHT clinical psychologists lowers the clinical threshold for referrals depends on which measures are deemed most critical. Consistently applying a composite index of referral ‘severity’ could prevent the former.

A profile of psychologists’ workload in Ireland

“…The tentative findings of this small-scale study could inform future research; for example, a larger scale study that includes independent monitoring of psychologists' caseloads (and associated caseload complexity; Curtis & Byrne, 2009) and how they spend their time. However, as quality of performance can lose out to quantification (e.g.…”

Teamwork Within Mental Health Services in Ireland: Resource Paper

“…Such an index (with higher weightings for factors that better discriminate between mild-to-moderate and severe mental health problems) could include diagnostic group, co-morbidity, chronicity, number and length of previous hospitalisations, associated functional impairment, previous deliberate self-harm and immediate safety, history and maturity of coping mechanisms, access to natural supports, and need for formal or informal care. 104 Consistent application of such a tool can shape appropriate referral behaviour over time, support caseload profiling for the purpose of ongoing peer consultation, and contribute to local needs assessment. …”