[Consultative psychiatry in the general practice]

Abstract

Background: The high demand for mental health care is increasing the pressure on Dutch basic and specialized mental health care. Consultative psychiatry in primary care may help to support primary mental health care. These consultations are increasingly used nationwide. However, little is known about how this help takes shape in practice and what the experiences of both patients and caregivers are.

Method: We carried out a database and file study into the characteristics of the patients who received psychiatric consultation, in which we also examined the consultation questions of the general practitioners (GP) and the given advice. In addition, 15 semi-structured in-depth interviews were conducted with patients, general practitioners, mental healthcare nurse practitioners and psychiatrists, after which the transcripts were coded and analyzed thematically.

Aim: To explore for which patients the GP requests a psychiatric consultation, what the consultation questions are and the advice given, and to identify the experiences of patients and healthcare providers with consultative psychiatry in general practice.

Results: The database study showed that consultative psychiatry was mainly used for patients with a psychiatric history, multiple psychiatric diagnosis and current psychopharmaceutical use. The consultation question usually concerned medication or treatment advice. In addition to advice regarding the consultation question, the psychiatrist often gave additional advice. Consultative psychiatry was experienced positively by both health care providers and patients due to the low threshold of the general practice, the mutual trust that is involved, the short waiting times compared to the second and third line psychiatry and the expertise of the psychiatrist.

Conclusion: Consultative psychiatry in general practice is widely applicable, but is mainly applied to patients with multiple psychiatric diagnoses and current psychopharmaceutical use. It is experienced as positive by both patients and healthcare providers.