General Practice and Mental Health Care: Determinants of Outpatient Service Use

Article excerpt

Objective: To examine the determinants that lead Canadian adults to consult family physicians, psychiatrists, psychologists, psychotherapists, and other health professionals for mental health reasons and to compare the determinants of service use across provider types.

Method: Data from the Canadian Community Health Survey: Mental Health and Well-Being were used for people aged 18 years and older (n = 35 236). A multivariate logistic regression was used to model outpatient consultations with different providers as a function of predictive determinants.

Result: Three types of variables were examined: need, enabling, and predisposing factors. Among need, the most common predictors of service use for mental health reasons were self-rated mental health, the presence of chronic conditions, depression and panic attacks, unmet mental health needs, psychological well-being, and the ability to handle daily demands. Among enabling factors, emotional and informational support and income were important predictors. Among predisposing factors, men were less likely to consult with a family physician and other resources but not with psychiatrists; and people with less education were less likely to consult psychologists and other health providers.

Conclusion: Need factors were the most important predictors of both psychiatrist and combined family physician and psychiatrist consultation in the previous year. However, sex barriers remain and promotion campaigns in seeking mental health care should be aimed toward men. Further, education and income barriers exist in the use of specialty providers of psychotherapy and policies should thus focus on rendering these services more accessible to disadvantaged people.

Can J Psychiatry. 2009;54(7):468-476.

Clinical Implications

* The presence of some disorders is more likely associated with consulting a psychiatrist, compared with other disorders.

* Socioeconomic factors do not play a role in consulting psychiatrists, but do so when consulting psychologists.

* Socioeconomic barriers to quality and adequate care may exist when it comes to providing psychotherapy as part of a complete package of mental health care in Canada.

Limitations

* Cross-sectional data do not permit the study of a shared care model between family physicians and psychiatrists.

* The recognition of mental disorders in primary care and the adequacy of treatment or referral patterns to psychiatrists and mental health specialists cannot be fully evaluated with the data.

* Mental health service use did not include hospitalizations and medications.

Key Words: mental health service use, mental health specialty, general practice

The presence of a mental disorder is often associated with serious role impairment, but most people do not use health care services.1-13 Both in Canada and in other jurisdictions, family physicians are found to be the major provider visited for mental health reasons. They play a key role in the management of mental health problems6,10,14-18 and efforts and initiatives to deliver quality mental health care have shifted toward the integration of primary care and specialized mental health services.19-23 The role of the family physician in mental health care relating to other providers is often unclear.24'25 National population-based surveys have shown that 9.5% of Canadians have reported service use for mental health reasons in the past 1 2 months and that most, 5 .4%, consulted a family physician.10 A recent Canadian study26 also showed that the perceived effectiveness of receiving help for mental health reasons from both a family physician and a mental health specialist, either a psychiatrist or psychologist, was significantly higher than those consulting just one professional. Interventions that include medication and psychotherapy are therefore key. There has been some investigation into the determinants of service use in the Canadian population,10 as well as some examination into differences between patients that seek help from a family physician, compared with a mental health specialist; however, little is known about patients that use a family physician and a mental health specialist. …