Literature Collection

OBJECTIVE(S): To assess the impact of a regional General Practitioner Psychiatry Phone Line (GPPPL), embedded in a public Community Mental Health service (CMHS) on the wider health service's workflow and systemic outcomes. DESIGN: Non-controlled population-based interventional study. SETTING: Public CMHS in the Great Southern region of Western Australia (WA). PARTICIPANTS: Aggregated monthly data on (i) referrals to the CMHS (July 2017-March 2022), and (ii) Emergency Department presentations (July 2017-May 2022) were obtained from the West Australian Country Health Service. INTERVENTION: Introduction of a regional GPPPL, for local publicly employed psychiatrists to provide specialist mental health care advice to General Practitioners working in the same region. MAIN OUTCOME MEASURES: Service input: Number of calls to the GPPPL, call duration and frequency. Service output: Rate of referrals to the CMHS, and rate of Emergency Department presentations related to mental health issues, and alcohol and other drugs. RESULTS: The number of weekly calls to the GPPPL decreased (slope -0.13, 95% CI -0.17, -0.08; p < 0.0001) over the course of the one-year pilot. The referral rate to CMHS was approximately 70.5 referrals per 1000 person-years in July 2017, and quite steady pre-GPPPL (p = 0.9283), then reduced significantly post-GPPPL, by 1.7 (95% CI 0.14, 3.26; p = 0.0372) referrals per 1000 person-years each month. CONCLUSIONS: This study has demonstrated the GPPPL's effectiveness in reducing the referral rates to CMHS and its self-sustainability. The psychiatrists involved were able to continue full-time public service roles while running the phoneline, with a decreasing time demand over the one-year pilot.

Background: Behavioral health services, integrated into primary care practices, have become increasingly implemented. Although patient satisfaction has been studied, limited information exists about patient preferences for integrated behavioral health in primary care and how perceptions may vary. Objective: To determine patient preferences for integrated behavioral health within primary care and explore differences across patient groups. Methods: A self-report survey was distributed within a quality improvement initiative in an academic health system. A brief 8-item self-report questionnaire of perceptions and preferences for integrated behavioral health was administered to 752 primary care patients presenting before their visits at two primary care clinics. Participation was voluntary, responses were anonymous, and all patients presenting during a three-week timeframe were eligible. Results: In general, patients preferred to have behavioral health concerns addressed within primary care (n = 301; 41%) rather than referral to a specialist (7.5%; n = 55). There was no evidence of variation in preferences by demographic characteristics. Comfort levels to receive behavioral health services (P < .001) and perceived needs being met were significantly associated with preferences for receiving IBHPC (P < .001). Conclusion: This project provided valuable data to support the implementation of integrated behavioral health services in primary care clinics. In general, patients prefer to have behavioral health issues addressed within their primary care experience rather than being referred to specialty mental health care. This study adds to an expanding pool of studies exploring patient preferences for integrated behavioral health in primary care.

Integrated health care (IHC) is efficacious, cost-effective, and more attractive to some consumers than traditional standalone psychotherapy, but the specific characteristics of IHC that drive this enhanced attraction have yet to be explored among potential future mental health consumers. As such, this brief report documents the results of a survey of 428 US adults who were asked to rank order the relative personal importance of seven characteristics (e.g., self-stigma mitigation, prompt appointment, saving money). These seven characteristics have been characterized in the IHC literature as potential beneficial elements of seeking mental health care from a provider in certain integrated health care settings. Getting sufficient information about one's health and treatment from one's provider was rated as most important, whereas co-location of mental/medical care and treatment privacy were rated as least important. The authors found evidence for select hypothesized demographic effects (e.g., interprovider communication rated more important for older adults) on how these factors were ranked. Professionals invested in developing and improving mental health care systems that are attractive and accessible to consumers in need of mental health care can consider the present findings when making decisions about which characteristics (e.g., getting sufficient information) should be maximized in the design and marketing of such systems. Future research, particularly longitudinal studies that assess prospective treatment seeking behavior, can build on the present study by examining the degree to which these attributes attract consumers to IHC settings.