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CMHTs neglect depression

Community mental health teams are ignoring GPs' recommendations and failing to prioritise the needs of patients with severe depression and anxiety, an evaluation reveals.

Researchers found that although GPs rated patients with depression and anxiety as in urgent need of attention, mental health teams were routinely prioritising patients with psychosis instead.

Almost a third of the surveyed teams did not believe they had an important role in the management of non-psychotic illnesses.But the researchers said part of the problem was the poor quality of GP referral letters.

The study found 94% of the GPs interviewed thought secondary care of patients with non-psychotic illnesses was 'very important' – as high a proportion as for psychosis. But among workers at community mental health teams the responses were distinct, with 100% prioritising psychosis but only 71% non-psychotic illnesses.

Study leader Dr Marta Buszewicz, a GP and senior lecturer in primary care and population sciences at University College London, said: 'GPs are finding it hard to get advice about management of non severely mentally ill patients. There's a concern not all are receiving appropriate care.'

But in the study, as many as 80% of community mental health team workers in Camden and Islington mental health trust reported the quality of GPs' referrals as variable, poor or very poor.

'There's a problem with referrals and GPs have to put their hands up to that. They don't always provide the information CMHTs want,' said Dr Buszewicz, a GP in north London.

But the RCGP said the problem was a lack of resources for depressed and anxious patients, and rigid and over-strict referral criteria. Professor Mayur Lakhani, chair of the college, said: 'Mental health problems are a significant part of a GP's workload and in my experience family doctors take time and trouble to craft good referral letters.'

He added: 'The real issue is how GPs are hampered by a lack of support in mental health – in particular practice-based psychological therapies. Services are developing increasingly rigid criteria for referral, which acts as a barrier because many patients do not fit neatly into categories.'

The Government has announced funding for psychological therapy services (see right), intended to fill the gap in care for depressed patients.

Psychological therapy aims

Psychological therapies may take the pressure off CMHTs to care for patients with depression.

• antenatal depression

• mental health of people with long-term conditions

• psychological problems in older people

• emotional and behavioural disorders in children and young people

• creating culturally appropriate services for black and ethnic minority communities.

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