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Referral for minor mental illness: a qualitative study.
S Nandy1, C Chalmers-Watson, M Gantley
1Department of General Practice and Primary Care, St Bartholomew's and Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS.
Summary
General practitioners (GPs) managing mild depression and anxiety use both rational and emotive decision-making for patient referrals. Understanding these varied referral strategies is key to improving mental healthcare.
Area of Science:
- General Practice
- Mental Health Research
- Qualitative Research Methods
Background:
- Mild depression and anxiety are prevalent in primary care settings.
- General Practitioners (GPs) exhibit significant variation in referral behaviors for these conditions.
- The underlying reasons for this referral variability remain unclear.
Purpose of the Study:
- To qualitatively explore and analyze the decision-making processes of GPs regarding the management of patients with minor mental illnesses.
- To understand the factors influencing GP referral decisions in primary care.
Main Methods:
- A qualitative interview study involving 23 General Practitioners (GPs) in East London and Essex.
- Purposive sampling and semi-structured interviews were employed.
- Grounded theory was utilized for data analysis.
Main Results:
- Two primary referral strategies were identified: 'containment' and 'conduit' approaches.
- Referrals were categorized as proactive ('referrals to') or reactive ('referrals away'), with the latter predominating for minor mental illness.
- GP decision-making on referrals was influenced by both rational and emotive factors.
Conclusions:
- Understanding GP referral variation requires acknowledging the role of emotive responses to minor mental illness.
- Current clinical guidelines may have limited impact if they assume solely rational decision-making by GPs.
- Future interventions should consider the emotional dimension of GP referral practices.