The in-house psychologist: do we speak the same language? Short report of a qualitative practice project
Interdisciplinary collaboration is gaining importance. Although general practices (GP’s) have a comprehensive experience in collabora tion with psychologists, research on this topic is scarce. In house referrals to a psychologist are assumed to lower the thresholds for patients and GP’s. In this study it was investigated whether the GP’s reasons to refer in were accor dance with the treatment strategy of the resid ing psychologist. The study is performed in a retrospective, observational cross section design. The studied population were the resid ing psychologist and GP’s. Both were asked to complete a questionnaire. Outcome measures where the referral reasons of the GP’s and the treatment strategy of the psychologist. A total sample of 92 patients of 6 GP’s was studied. Over 60% of the patients were referred for coun seling but only in 25% of the cases this proposal was carried out by the psychologist. Overall, the referral reasons of the GP’s were not in accor dance with the treatment strategy of the psy chologist. A close collaboration and communica tion between general practitioners and psychol ogists is both difficult and indispensable. This practice research demonstrated that the referral motives of the GP’s usually do not correspond to the treatment policy of the psychologist. This observation is partly explained by a lack of understanding of the GP in the treatment strategies of the psychologists. Another part of the explanation is that there is a pre-selection of the GPs referrals rather influenced by patient characteristics than by pathology.
1. Ashworth M, Clement S, Sandhu J, et al. Psychiatric referral rates and the influence of on-site mental health workers in general practice. Br J Gen Pract 2002;52:39-41.
2. Cape J, Parham A. Relationship between practice counselling and referral to outpatient psychiatry and clinical psychology. Br J Gen Pract 1998;48:1477-80.
3. Tata P, Eagle A, Green J. Does providing more accessible primary care psychology services lower the clinical threshold for referrals? Br J Gen Pract 1996;46:469-72.
4. Clatney L, Macdonald H, Shah SM. Mental health care in the primary care setting: family physicians’ perspectives. Can Fam Physician 2008;54:884-9.
5. Sigel P, Leiper R. GP views of their management and referral of psychological problems: a qualitative study. Psychol Psychother 2004;77:279-95.
6. Raine R, Lewis L, Sensky T, et al. Patient determinants of mental health interventions in primary care. Br J Gen Pract 2000;50:620-5.
7. Gulbrandsen P, Hjortdahl P, Fugelli P. General practitioners’ knowledge of their patients’ psychosocial problems: multi-practice questionnaire survey. BMJ 1997;314:1014-8.
8. Kovess-Masfety V, Saragoussi D, Sevilla-Dedieu C, et al. What makes people decide who to turn to when faced with a mental health problem? Results from a French survey. BMC Public Health 2007;7:188.
9. Bushnell J, McLeod D, Dowell A, et al. Do patients want to disclose psychological problems to GPs? Fam Pract 2005;22:631-7.
10. Hull SA, Jones C, Tissier JM, et al. Relationship style between GPs and community mental health teams affects referral rates. Br J Gen Pract 2002;52:101-7.
11. Schulte TJ, Isley E, Link N, et al. General practice, primary care, and health service psychology: concepts, competencies, and the combined-integrated model. J Clin Psychol 2004;60:1011-25.
12. Bushnell J, McLeod D, Dowell A, et al. The treatment of common mental health problems in general practice. Fam Pract 2006;23:53-9.
13. Raine R, Lewis L, Sensky T, et al. Patient determinants of mental health interventions in primary care. Br J Gen Pract 2000;50:620-5.
14. Jorm AF, Korten AE, Jacomb PA, et al. Beliefs about the helpfulness of interventions for mental disorders: a comparison of general practitioners, psychiatrists and clinical psychologists. Aust N Z J Psychiatry 1997;31:844-51.
15. Freiberg-Golvan D, Fradkin P, McCormack H, et al. Working together. General practitioners and psychologists. Aust Fam Physician 1988;17:998-9.
16. Salmon P, Stanley B, Milne D. Psychological problems in general practice patients: two assumptions explored. Br J Clin Psychol 1988;27:371-9.
17. Younes N, Gasquet I, Gaudebout P, et al. General practitioners’ opinions on their practice in mental health and their collaboration with mental health professionals. BMC Fam Pract 2005;6:18.