ANALYSIS OF REFERRALS OF MENTAL-HEALTH PROBLEMS BY GENERAL-PRACTITIONERS

The majority of people in the community who have a psychiatric disorde r will consult their general practitioner. Referrals from general prac tice to specialist services are, however, relatively rare. The filter between primary care and specialist care has been characterized by Gol dberg and Huxley as the least permeable of the filters separating psyc hiatrists and other specialists from the populations they serve. These referrals form the subject of this study in the Netherlands. Using a large database of doctor-patient contacts, the proportion of mental he alth disorders resulting in a referral and the characteristics of the patient and general practitioner that are involved in such a referral have been determined. In addition, the type of mental health instituti on or specialist to which referrals were directed and the characterist ics influencing this choice were examined. Only 6% of patients present ing with a psychiatric disorder during surgery hours were referred to specialist care. Younger patients, male patients and patients with sev ere diagnoses had a greater probability of being referred. The percent age of patients referred was higher in urban areas than in rural areas . Doctors with a limited task perception regarding mental treatment te nded to refer more often. Although the diagnosis did have some relatio nship with the institutions to which patients were referred (psychotic conditions to psychiatric services and social/material problems to so cial workers), the most prevalent diagnoses (neurotic conditions and r elationship problems) seemed to be more or less randomly distributed o ver the various possibilities. Preferences appeared to be related to t he existence of regular meetings between general practitioners and spe cialists and a positive evaluation by general practitioners of the ins titution concerned.