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Comparison of integrated and consultation-liaison models for providing mental health care in general practice in New South Wales, Australia.

Comparison of integrated and consultation-liaison models for providing mental health care in general practice in New South Wales, Australia The characteristics of a new service providing integrated mental health care in general practice are described and comparisons made with an earlier consultation-liaison (C-L) psychiatry service in general practice, including the range and severity of psychiatric problems, levels of general practitioner (GP) and psychiatrist involvement, and patterns of care. Clinical audit checklists were completed by two experienced mental health nurses for the first 100 patients referred to the service, which was conducted in conjunction with 8 general practices in the Port Stephens region of New South Wales, Australia. The mean age of the first 100 referrals was 38.05 years, 63.0% were female, and 55.0% were referred from GPs. Outcome measures included: referral information, patients' demographic and diagnostic characteristics, psychosocial functioning, psychotropic medication, management, and number of contacts with the mental health nurses. Relative to the earlier C-L psychiatry service in general practice, the integrated service treated a broader range of diagnostic groups with higher levels of disability. There were higher rates of mood (48.0%) and psychotic (20.0%) disorders and lower rates of adjustment (2.0%) disorders. One-third of patients were seen by an additional agency, other than the mental health nurses or GPs. Patients averaged 4.95 contacts with the mental health nurses, with marked variations according to diagnostic group. To date, the new service has been well received. It is highly accessible, acceptable to GPs and patients, caters for a broad range of psychopathology, including severe mental illness, and appears to be sufficiently versatile to be adaptable to a variety of treatment settings.