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Mental health care in the primary care setting

Family physicians’ perspectives

Heather MacDonald, MSc
Director of Regional Initiatives with Capital Health in Edmonton, Alta

Syed M. Shah, MBBS MPH PhD
Associate Professor in the Department of Community Health and Epidemiology at the University of Saskatchewan in Saskatoon

Correspondence to: Lisa Clatney, Health Quality Council, 241—111 Research Dr, Saskatoon, SK S7N 3R2; telephone 306 668-8810, extension 106; fax 306 668-8820; e-maillclatney{at}hqc.sk.ca

OBJECTIVE To assess family physicians’ interactions with mental health professionals (MHPs), their satisfaction with the delivery of mental health care in primary health care settings, and their perceptions of areas for improvement.

DESIGN Mailed survey.

SETTING Province of Saskatchewan.

PARTICIPANTS All FPs in Saskatchewan (N = 816) were invited to participate in the study; 31 were later determined to be ineligible because they were specialist physicians, were no longer practising regularly, or could not be located.

MAIN OUTCOME MEASURES Family physicians’ self-reported satisfaction with and interest in mental health care; perceived strengths and areas for improvement in the quality of mental health care delivery in primary health care settings.

RESULTS The response rate was 48%, with 375 FPs completing the survey. More than half of the responding FPs (56%) reported seeing 11 or more patients with mental health problems per week. Although 83% of responding FPs were interested or very interested in identifying or treating mental health problems, fewer than half (46%) reported being satisfied with the mental health care they were able to deliver. Family physician satisfaction was significantly higher among those with on-site MHPs (P < .05) and those who saw fewer patients with mental health problems per week (P < .01). The most common mode of interaction that FPs reported having with MHPs was through written correspondence; somewhat less common were telephone and face-to-face interactions. The most common strength FPs identified in their provision of mental health care was having access to psychiatrists, community mental health nurses, and other MHPs. The most common area for improvement in primary mental health care also fell under the category of access. Specifically, FPs felt access to psychiatrists needed to be improved.

CONCLUSION Mental health problems are very common in primary care. Most FPs are very interested in the detection and treatment of mental health problems. Despite this high level of interest, however, FPs are generally dissatisfied with the quality of mental health care they are able to provide. Access to MHPs was cited as a critical element in improving the delivery of mental health services in primary care.