Evaluating models of working at the interface between mental health services and primary care

BACKGROUND: This paper examines the feasibility of evaluating innovative models of working at the interface between primary care and secondary mental health services. METHOD: Methodological problems relevant to evaluation of innovative models of working at the interface are discussed. RESULTS: Although there is some evidence that neurotic disorders can be more cost-effectively treated in primary care, many general practitioners (GPs), and possibly some patients, prefer referral to community mental health teams and community psychiatric nurses, which are provided by the secondary health care services. Since the latter are provided with the intention of improving serious mental illness their involvement in the care of neurotic illness can lead to tensions between GPs, local health authorities and service providers. There is little evidence to suggest that psychiatrists working in health centres using the 'shifted out-patient' model have eased this problem. By contrast the 'consultation-liaison' (C-L) model has a number of theoretical advantages; referrals to secondary care should be limited to those most in need of this level of expertise and GP management skills should improve, so leading to better quality of care for patients who are not referred. CONCLUSION: Studies comparing the different models of service delivery are required to address the tensions that have arisen following changes in government policy. Further work is also needed to develop the necessary research tools.