Individuals with mild to moderate mental health problems don’t need to see a specialty to receive quality treatment, according to new research.
That’s the predominant finding from a study by the University of Cambridge based on a trial in Indonesia, where there is a shortage of mental health professionals. Although seeing a specialist may be more cost-effective in the long term, seeing a general practice provider could reduce the stigma around needing mental health treatment, the researchers note. They add that their findings are relevant not just in the UK but in any country where patients often wait a long time for mental health appointments.
How Did the Study Work?
In 2008, the World Health Organization (WHO) created the WHO Mental Health Gap Action Programme (WHO mhGAP) to support countries in increasing services for mental health, neurological and substance abuse disorders. In 2015, the Indonesian Ministry of Health rolled out the program to some GPs and nurses in its network of community health centers. The Cambridge researchers compared the effectiveness of the program, which helped 153 patients complete treatment at 14 primary care clinics, to the outcomes of another 141 patients who saw specialist clinical psychologists.
Researchers found the mental health care provided by GPs equally as effective for mild to moderate conditions as care by a specialist — and that GPs helped several participants go into remission. Both groups improved about the same in health and social functioning, quality of life, and disability reduction at their six-month follow-up.
Why Should GPs Provide Mental Health Care?
There are several advantages to having a GP manage an individual’s mental health care, Sabrina Anjara, PhD, one of the study’s lead authors, tells Florence Health. “Firstly, patients trust their GPs and therefore would be more willing to disclose their symptoms,” she says. “The therapeutic alliance that usually takes some time to develop between a therapist and a patient tends to already exist with GPs.”
She adds that seeing a GP for mental health means the patient doesn’t have to be on a long waiting list and it can avoid the stigma. “While employees may fear disclosing mental health appointments to their workplace, there is no such stigma with a GP appointment,” she points out.
“Lastly, many people presenting with mental health problems also have physical ailments,” Dr. Anjara continues. “The GP is well-placed to address these conditions simultaneously and is aware of possible drug interactions. Care is more holistic and perhaps even safer for patients.”
Why Does the Study Matter?
Around the world, only one in three people suffering from psychosis receive the care they need — a treatment gap of 32 percent. Experts estimate this figure is almost three times higher, above 90 percent, in low and middle-income countries. According to Dr. Anjara, the WHO mhGAP program has potential to shrink the gap greatly, especially in areas where the demand for care surpasses its availability.
Dr. Anjara also believes nurses will play an even greater role in the program’s future.
“Nurses are integral in enabling the provision of talk therapies in the clinics, and they help patients with their adherence to prescriptions,” she says. “In other contexts and depending on availability, I believe psychiatric nurses or advanced nurse practitioners could be deployed to manage mental health in primary care. This could be tested and evaluated in specific countries or districts.”