Psychiatric service within primary care

Abstract

The organization of a psychiatric specialist service integrated in primary care is described. One of the aims was to replace admissions to the mental hospital with consultation and treatment within primary care. An 18% reduction of admissions was achieved over a 2-year period. The staff at the local mental hospital to a large extent controlled the number of admissions. Lack of cooperation from part of the staff made a greater reduction of admissions difficult. It is argued that in order to achieve a true shift from institutional to community psychiatry, the use of the hospital beds should be monitored from the community level.

The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study

“…This study uses a quasi-experimental design to address these knowledge gaps by comparing the outcomes of two shelter-based collaborative mental health care models [ 41 – 44 ] for individuals facing homelessness and mental illness: (1) an integrated multidisciplinary collaborative care (IMCC) model (liaison attachment model) and (2) a less resource intensive shifted outpatient collaborative care (SOCC) model. Studies conducted in samples of individuals with mental health conditions have shown that both types of models may increase accessibility to mental health services [ 36 , 45 , 46 ], improve clinical outcomes [ 47 ], reduce hospitalizations [ 48 , 49 ] and result in high provider [ 45 , 50 , 51 ] and patient satisfaction [ 52 , 53 ]. These studies, however, were not conducted in homeless populations, experiencing additional challenges in having their health and social needs met.…”

Psychiatry and Primary Care

“…This typically results in a system in which each community nurse looks after a set of patients who are under the care of many different GPs, so that a close working relationship between GP and community nurse is difficult to sustain. Goldberg and Gournay (6) argued that most mental disorders should be looked after in primary care, with severe mental disorders (schizophrenia, bipolar illness and dementia) jointly under the care of mental health services with a "shared care" plan, and other disorders treated by primary care services unless they failed to respond to treatment from the GP. It was suggested that severely ill patients under the care of a particular GP should all, as far as possible, be cared for by the same mental health worker -who would therefore act as a "link worker" between the two services.…”