Clinical characteristics and patterns of referral to a primary mental health team: A retrospective study

Introduction: The Primary Mental Health Team (PMHT) initiative in Victoria began almost 10 years ago, but there has been little evaluation of this important strategy to improve integration between mental health services and primary care. The present study investigated the demographic and clinical characteristics of patients referred to a PMHT in order to guide development of the service and better meet the needs of primary care providers and their patients. Methods: The referral forms (n = 153) and assessment records (n = 89) of patients referred consecutively to a PMHT over a 12-month period were investigated in a retrospective file review. Results: Most referrals were from general practitioners requesting consultations. Sixty-five percent of patients were female, 41% were not in a relationship and 47% were unemployed. Fewer children and elderly people were referred. Illnesses tended to be chronic with multiple symptoms, and in half of those referred there had been a poor response to treatment in primary care. Many were victims of abuse and used substances. Medical illnesses were often present and levels of psychosocial stress and functional impairment were high. Referrers appeared to overestimate risk, over diagnose depression, and under diagnose personality disorders and mixed anxiety and depression. Psychotherapy was the most common recommendation made by the PMHT. Discussion: In spite of the limitations of this study the findings are a useful description of the PMHT experience. The review enabled the team to describe and better understand the needs of primary care providers and their patients, and had a significant impact on the subsequent development and expansion of the PMHT.