Literature Collection

BACKGROUND: There is an increased risk of mood changes in perimenopause, and evidence that patients and GPs may overlook this association. Evidence also shows that GPs have a lack of confidence in managing perimenopausal symptoms. AIM: To examine clinical consultations for patients in the perimenopausal age range who were presenting with mental health symptoms, and the experiences of GPs providing care to such patients. DESIGN & SETTING: A qualitative study was undertaken in one integrated care system in south-west England. It involved 18 women aged 45-55 years, who had consulted with their GP about a mental health symptom in the previous 6 months, and 11 GPs. METHOD: Participants were recruited between February 2023 and August 2023. Data were collected through semi-structured interviews, and thematic analysis was used to identify recurring patterns and key insights regarding consultation practices, patient-GP communication, and gaps in education and training. RESULTS: Women either did not recognise perimenopause or were uncertain whether it contributed to their mental health symptoms, and felt inhibited or embarrassed about raising the issue. GPs reported using variable approaches to asking about perimenopausal symptoms and acknowledged that there were gaps in their training. Time constraints and the stigma surrounding menopause further hindered consultations. CONCLUSION: Addressing mental health symptoms during perimenopause requires a proactive and informed approach in primary care. Improved GP training on menopause, coupled with patient education to increase awareness and confidence, could improve consultations and the management of mental health symptoms experienced during perimenopause.

Mental health conditions are up to 2 to 3 times more common across a woman's lifespan depending on the condition, making it important to screen for these conditions and be aware of key treatment differences compared to men. Medication choices should take into account a woman's reproductive potential.

To explore the receipt of mental health education, assessment, and referrals, and mental health service use among individuals with vestibular disorders. Patients with vestibular disorders living in the US, Australia, Canada, and the UK were surveyed through social media forums. Questionnaires assessed demographics, anxiety (Generalized Anxiety Disorder-7), depression (Center for Epidemiological Studies Depression-10), dizziness (Dizziness Handicap Inventory), and type of professional providing mental health education, assessment, referral, and treatment. The 226 participants were largely White (90%), educated (67% holding an associate's degree or higher) women (88%) with an average age of 45 who self-identified as having chronic vestibular symptoms (78%), as opposed to episodic ones (22%). Fifty-two percent reported never receiving verbal education, written education (69%), mental health assessment (54%), or referral (72%). Participants were more likely to receive mental health treatment in the past if they had received verbal resources and/or referrals from clinicians. The majority of patients with vestibular disorders report that medical professionals have not provided education, mental health assessment, or a mental health referral.

BACKGROUND: In the state of Victoria, Australia, the 111-day lockdown due to the COVID-19 pandemic exacerbated the population's prevailing state of poor mental health. Of the 87% of Australians who visit their GP annually, 71% of health problems they discussed related to psychological issues. This review had two objectives: (1) To describe models of mental health integrated care within primary care settings that demonstrated improved mental health outcomes that were transferable to Australian settings, and (2) To outline the factors that contributed to the effective implementation of these models into routine practice. METHODS: A scoping review was undertaken to synthesise the evidence in order to inform practice, policymaking, and research. Data were obtained from PubMed, CINAHL and APA PsycINFO. RESULTS: Key elements of effective mental health integrated care models in primary care are: Co-location of mental health and substance abuse services in the primary care setting, presence of licensed mental health clinicians, a case management approach to patient care, ongoing depression monitoring for up to 24 months and other miscellaneous elements. Key factors that contributed to the effective implementation of mental health integrated care in routine practice are the willingness to accept and promote system change, integrated physical and mental clinical records, the presence of a care manager, adequate staff training, a healthy organisational culture, regular supervision and support, a standardised workflow plan and care pathways that included clear role boundaries and the use of outcome measures. The need to develop sustainable funding mechanisms has also been emphasized. CONCLUSION: Integrated mental health care models typically have a co-located mental health clinician who works closely with the GP and the rest of the primary care team. Implementing mental health integrated care models in Australia requires a 'whole of system' change. Lessons learned from the Mental Health Nurse Incentive Program could form the foundation on which this model is implemented in Australia.