Mental health services in primary care: the impact of postgraduate training for GPs Mimi Copty, David L Whitford Original Ir J Psych Med 2005; 22(3): ??-?? Abstract Objectives: To determine the extent of mental health services provided in the community in one Irish Health Board area. To examine the influence of postgraduate mental health training of GPs on provision of mental health services. Method: Questionnaire and focus group methods were employed to determine views on mental health service provision. Data analysis was with parametric and non- parametric tests of association including Students t and chi-squared tests. Thematic analysis of the focus groups was carried out. Results: 25% of patients attending general practice have mental health problems and over 95% of these problems are dealt with in primary care. Only 32% of GPs had received postgraduate training in psychological therapies. GPs with postgraduate training in psychological therapies were more likely to estimate a higher proportion of their patient population with mental health problems and less likely to refer to psychiatric services. A need for support from other health care professionals in primary care was also identified. Conclusion: The majority of patients with mental health problems are treated in primary care. Further training of GPs and increased resources would improve mental health care in primary care and lead to fewer referrals to psychiatric services. Key words: General practice; Primary care; Mental health; Psychiatric services; Training. Background National and international reports have recommended a shift of mental health services from hospital to the commu- nity, increased provision of mental health services in primary care, a greater integration of mental health services and provi- sion of a comprehensive mental health service. 1-3 Although the majority of mental health problems are dealt with in primary care 4 there is evidence that some general practitioners (GPs) have insufficient psychiatric training 5,6 and that the desired integration of mental health services has not been fully achieved. 7 Urban Ireland has been found to have the highest prevalence of depressive disorder in Europe 8 and would therefore merit an advanced system of community mental health services. This study set out to determine the extent of mental health services provided in the community in one Health Board area of Ireland and to examine the potential for future provision of mental health services in the community setting. Method This study was conducted in the area covered by the South Western Area Health Board (SWAHB) in 2003. The SWAHB serves a population of 580,000 people, 362 GPs and 30 psychiatrists provide services to this population. The views of GPs and psychiatrists on primary care mental health services were elicited through questionnaires. Ques- tionnaires were developed utilising the study objectives, previous literature and personal experience. Input was obtained from a steering group consisting of primary care and mental health service providers. The questionnaire was subsequently piloted among GPs at a conference on suicide prevention, following which appro- priate changes were made. The final version of the GP questionnaire included questions on GP demographics, provision of mental health services in general practice and GP perceptions of mental health services. This was mailed to the 362 GPs in the SWAHB area. Two reminders were sent to non-responders. A similar questionnaire for psychia- trists was developed and mailed to 30 psychiatrists, followed by telephone reminders to non-responders. Data analysis was with SPSS v11.0 using parametric and non-parametric tests of association including Students t and chi-squared tests. P < 0.05 was taken as significant. The questionnaire survey was followed by three focus groups to further explore issues around the delivery of mental health services. The focus group participants were, respec- tively, five GPs, eight service users and eight mental health service providers (psychologists, social workers, counsellors and occupational therapists). Thematic analysis of the focus groups was carried out. Results A total of 231 GPs returned questionnaires (64% response rate). Responders were representative of the GP population in the SWAHB in terms of age and gender (Table 1). Of psychiatrists, 23 returned questionnaires (77% response rate). Current management in general practice GP estimates of the proportion of their patients with mental health problems ranged from 1% to 90% with half of the responding GPs estimating in the range 15%-32%. The mean estimate of the proportion of patients with mental ?? Mimi Copty, MHSA, BA, Project Director, Mental Health in Primary Care, Irish College of General Practitioners, Lincoln Place, Dublin 2, Ireland. David L Whitford, MA, MD, Senior Lecturer in General Practice, Department of General Practice, Royal College of Surgeons in Ireland, Dublin 2, Ireland. *Correspondence SUBMITTED: NOVEMBER 17, 2004. ACCEPTED: JUNE 20, 2005.