29 Better identification and treatment of mental disorders in primary care

© Salvatore Vinci

Only few people suffering from depression or anxiety benefit from adequate and prompt diagnosis and treatment. A newly developed training for general practitioners in combination with support and advise from specialists can improve the detection, diagnosis and treatment of mental disorders.

  • Project description (completed research project)

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    General practitioners in the greater Zurich area were invited to participate in the project and allocated randomly to an intervention group and a control group. The intervention group was trained to recognise patients with mental disorders. Practitioners in this group also received support and advice from specialised mental health professionals (psychotherapists and psychiatrists) who became involved directly in the therapy upon demand. The control group did not receive additional specialist support. The mental health status of the participating patients as well as costs of the interventions were determined at various time points over a total duration of 12 months. The effects of the intervention were analysed by comparing the results between the intervention and control group. In addition, the implementation processes were analysed, i.e., the ways how the new service works and matches with patients’ and general practitioners’ needs.

  • Background

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    Studies show that just one in three people in Switzerland with a mental disorder receives adequate treatment. This increases the risk for impaired health, chronic course of the disorder and high costs for the health and social welfare systems. The main reasons for insufficient care are poor early detection, inadequate treatment and wait lists for specialist treatment. Because primary care serves an important function in the early detection and treatment of mental health problems the role of general practitioners needs to be strengthened.

  • Aim

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    The goal of this project was to develop a new service that supports primary care practices in the early identification, diagnosis and treatment of patients with common mental disorders, particularly depression and anxiety. The implementation process, efficacy, cost-effectiveness, feasibility and acceptability of this new comprehensive intervention are evaluated.

  • Results

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    Starting from November 2019, the novel service — the “Fachstelle Psychische Gesundheit” (Center for Mental Health, CMH) — was implemented. The CMH consists of an interprofessional team of trained psychotherapists and psychiatrists. The study results showed that the service achieved its goals: Patients were identified at an early stage of their current problems, and most patients needed further treatment initiation. The services of the CMH were utilized by substantially distressed patients with a validated diagnosis of a depressive or anxiety disorder. Most seen patients received a recommendation for further mental health treatment, such as outpatient psychotherapy or consultations of a psychiatrist.

    Overall, the study was strongly impacted by the Covid-19 pandemic. Research was difficult due to contact restrictions and due to lack of time and resources at the practices. Because of this delay, the study continues beyond the end of the project.

  • Relevance / Application

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    Significance of the results for research:

    The first results show that the new service was successfully imple-mented and probably adds to a better detection, diagnosis and treatment of mental disorders, particularly depression and anxiety, in the primary care setting.

    Significance of the results for practice:

    To benefit the patients, the intervention supports the treatment process as early as possible, i.e., when the question arises of what problem the patient has and what treatment should be selected. To achieve these aims and better help patients with complex mental health problems, increased collaboration of general practitioners and mental health experts is necessary.

  • Original title

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    Improving care for patients with depressive and anxiety disorders in primary and secondary care