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A potential model for primary care mental health services in Ireland

Published online by Cambridge University Press:  13 June 2014

Joanne Kierans
Affiliation:
Roscommon PCCC, HSE
Michael Byrne*
Affiliation:
Roscommon PCCC, HSE, Ireland
*
*Correspondence E-mail: [email protected]

Abstract

Objectives:

A high demand for the inclusion of psychosocial interventions for primary care mental health presentations has become more apparent in recent years. Current policies have proposed models of care highlighting principles required for a quality service. However, implementation has been slow to date. This article aims to inform the current debate relating to primary care service delivery models for mental health presentations and to contribute towards future planning initiatives.

Method:

A narrative review of a range of policies and selected articles relevant to primary care mental health in an Irish context.

Results:

The search produced four distinct themes: current service provision in Ireland; stakeholders' views; psychological care options; and potential service structures. Thereafter, a potential service delivery model is proposed. This formulated model employs a combination of elements from the reviewed themes to provide a clinically- and cost-effective, equitable and accessible service driven by service user and carer input.

Conclusions:

Although this review was selective in nature, the proposed potential model can complement future research agendas for more favourable primary care practice in Ireland. Recommendations are made for the planning of services including policy implementation procedures, training and communication.

Type
Perspective
Copyright
Copyright © Cambridge University Press 2010

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References

1.Byrne, M.A response to the Mental Health Commission's discussion paper ‘Multidisciplinary Team Working: From Theory to Practice’. The Irish Psychologist 2006c; 32(12): 323–9.Google Scholar
2.World Health Organisation. The World Health Report 2001 — Mental Health: New Understanding, New Hope. Geneva: WHO; 2001.Google Scholar
3.Department of Health. Treatment Choice in Psychological Therapies and Counselling: Evidence Based Clinical Practice Guideline, 23044. Department of Health: London; 2001.Google Scholar
4.O'Neill, M, Cowman, S.Partners in care: investigating community nurses' understanding of an interdisciplinary team-based approach to primary care. J Clin Nurs 2008;17: 3004–11.CrossRefGoogle ScholarPubMed
5.Nolan, P, Orford, J, White, A, Smith, J.Professional views on managing common mental health problems in primary care. Primary Care Ment Health 2003; 1: 2736.Google Scholar
6.Department of Health. The Psychiatric Services – Planning For the Future, PI 3001. Dublin: Stationary Office; 1984.Google Scholar
7.Department of Health and Children. A Vision for Change: Report of the Expert Group on Mental Health Policy. Dublin: Stationary Office; 2006.Google Scholar
8. Mental Health Commission. Annual Report 2008. The Mental Health Commission: Dublin; 2008.Google Scholar
9.Hughes, M, Byrne, M, Synnott, J.Prevalence of psychological distress in General Practitioner adult attendees. Clin Psychol Forum 2010; 206: 33–8.CrossRefGoogle Scholar
10.Hemmings, A.A Systematic Review of the Effectiveness of Brief Psychological Therapies in Primary Health Care. Fam Syst Health 2000; 18: 279313.CrossRefGoogle Scholar
11.Whitford, DL, Copty, M.General practice in Ireland: are we equipped to manage mental health? Ir J Psych Med 2005; 22(2): 40–1.CrossRefGoogle ScholarPubMed
12.Mercer, SW, Smith, SM, Wyke, S, O'Dowd, T, Watt, GCM.Multimorbidity in primary care: developing the research agenda. Fam Pract 2009; 26(2): 7980.CrossRefGoogle ScholarPubMed
13.Buchan, T, Boldy, DP.Improving mental health services in a local area — an exploratory study. Aust Health Rev 2004; 28(3): 292300.CrossRefGoogle Scholar
14.Gilmore, KA, Hargie, O.Quality issues in the treatment of depression in general practice. Int J Health Care Qual Assur 2000; 13(1): 3441.CrossRefGoogle ScholarPubMed
15.Ni Shiothcháin, A, Byrne, M.What do GPs want from mental health services? The Irish Psychiatrist 2009b; 10(1): 42–4.Google Scholar
16.Lester, HE, Glasby, J, Tylee, A.Integrated primary mental health care: threat or opportunity in the new NHS? Br J Gen Pract 2004; 54(501): 285–91.Google ScholarPubMed
17.Wright, B, Russell, V.Integrating mental health and primary care services: a challenge for psychiatric training in Ireland. Ir J Psych Med 2007; 24(2): 71–4.CrossRefGoogle ScholarPubMed
18.Department of Health and Children. Primary Care: A New Direction. Dublin: Stationary Office; 2001.Google Scholar
19.Gum, AM, Arean, PA, Hunkeler, Eet al.Depression Treatment Preferences in Older Primary Care Patients. Gerontologist 2006; 46(1): 1422.CrossRefGoogle ScholarPubMed
20.Bortolotti, B, Menchetti, M, Bellini, F, Montaguti, MB, Berardi, D.Psychological interventions for major depression in primary care: a meta-analytic review of randomized controlled trials. Gen Hosp Psychiatry 2008; 30: 293302.CrossRefGoogle ScholarPubMed
21.Bower, P, Byford, S, Sibbald, Bet al.Randomised controlled trial of nondirective counselling, cognitivebehaviour therapy, and usual general practitioner care for patients with depression. II: Cost effectiveness. BMJ 2000; 321: 1389–92.CrossRefGoogle ScholarPubMed
22.Kennedy, T, Jones, R, Darnley, S, Seed, P, Wessely, S, Chalder, T.Cognitive behaviour therapy in addition to antispasmodic treatment for irritable bowel syndrome in primary care: randomised controlled trial. BMJ 2005; 331 (7514): 435–40.CrossRefGoogle ScholarPubMed
23.Hollon, SD, Thase, ME, Markowitz, JC.Treatment and Prevention of Depression. Psychol Sci in the Public Interest 2002; 3(2): 3977.CrossRefGoogle ScholarPubMed
24.Ransom, DC, Fisher, L.Responses to “a Systematic review of brief psychological therapies in primary health care”. Fam Syst Health 2000; 18(3): 323–6.CrossRefGoogle Scholar
25.Cuijpers, P, van Straten, A, Warmerdam, L.Behavioral activation treatments of depression: A meta-analysis. Clin Psychol Rev 2007; 27: 318–26.CrossRefGoogle ScholarPubMed
26.Milne, D, Souter, K.A re-evaluation of the clinical psychologist in general practice. J R Coll Gen Pract 1988; 38: 457–60.Google ScholarPubMed
27.Laidlaw, K, Davidson, K, Toner, Het al.A randomised controlled trial of cognitive behaviour therapy vs treatment as usual in the treatment of mild to moderate late life depression. Int J Geriatr Psychiatry 2008; 23: 843–50.CrossRefGoogle ScholarPubMed
28.DeRubeis, RJ, Gelfand, LA, Tang, TZ, Simons, AD.Medications Versus Cognitive Behavior Therapy for Severely Depressed Outpatients: Mega-Analysis of Four Randomized Comparisons. Am J Psychiatry 1999; 156: 1007–13.CrossRefGoogle ScholarPubMed
29.Gilbert, N, Barkham, M, Richards, A, Cameron I. The effectiveness of a primary care mental health service delivering brief psychological interventions: a benchmarking study using the CORE system. Primary Care Ment Health 2005; 3: 241–51.Google Scholar
30.Sharp, DM, Power, KG.Psychologist, patient and general practitioner ratings of outcome of pharmacological and psychological treatments for panic disorder and agoraphobia in primary care. Behav Cognit Psychother 1998; 26: 1327.CrossRefGoogle Scholar
31.Clark, DM, Layard, R, Smithies, R.Improving access to psychological therapy: initial evaluation of the two demonstration sites. Centre for Economic Performance: London; 2008.Google Scholar
32.Lovell, K, Bower, P, Richards, Det al.Developing guided self-help for depression using the Medical Research Council complex interventions framework: a description of the modelling phase and results of an exploratory randomised controlled trial. BMC Psychiatry 2008; 8(ArtlD 91).Google Scholar
33.Proudfoot, J, Ryden, C, Everitt, Bet al.Clinical efficacy of computerised cognitive- behavioural therapy for anxiety and depression in primary care: randomised controlled trial. Br J Psychiatry 2004; 185: 4654.CrossRefGoogle ScholarPubMed
34.Arboleda-Florez, J, Saraceno, B.Mental health and primary care. Can Med Assoc J 2001; 164(7): 1013–4.Google ScholarPubMed
35.Corrigan, PW.Enhancing personal empowerment of people with psychiatric disabilities. Am Rehabil 2004; 28(1): 1021.Google Scholar
36.Arthur, AR.Layered care: a proposal to develop better primary care mental health services. Primary Care Ment Health 2005; 3: 103–9.Google Scholar
37.Bower, P, Gilbody, S.Stepped care in psychological therapies: access, effectiveness and efficiency. Br J Psychiatry 2005a; 186: 11–7.CrossRefGoogle ScholarPubMed
38.Bower, P, Gilbody, S.Managing common mental health disorders in primary care: conceptual models and evidence base. BMJ 2005b; 330: 839–42.CrossRefGoogle ScholarPubMed
39.Smit, A, Tiemens, BG, Ormel, J.Improving long-term outcome of depression in primary care: a review of RCTs with psychological and supportive interventions. Eur J Psychiat 2007; 21(1): 3748.CrossRefGoogle Scholar
40.Pidd, F.Primary care and mental health — still travelling hopefully? The Mental Health Review 2004; 9(4): 712.CrossRefGoogle Scholar
41.Lovell, K, Richards, D.Multiple access points and levels of entry (MAPLE): ensuring choice, accessibility and equity for CBT services. Behav Cognit Psychother 2000; 28: 379–91.CrossRefGoogle Scholar
42.McCarthy, T.A modern guide to primary care mental health services. Mental Health Strategies: Manchester; 2001.Google Scholar
43.Winefield, HR, Chur-Hansen, A.Integrating Psychologists into Primary Mental Health Care in Australia. Fam Syst Health 2004; 22(3): 294305.CrossRefGoogle Scholar