PROVISION OF CARE TO GENERAL-PRACTICE PATIENTS WITH DISABLING LONG-TERM MENTAL-ILLNESS - A SURVEY IN 16 PRACTICES

Background Increasing numbers of long-term mentally ill people now liv e in the community, many of whom lose contact with psychiatric service s and come to depend on general practitioners for medical care. Howeve r, it has been suggested that general practitioners may be unaware of some of these patients and their needs. Aim. This study set out to inv estigate the care received by this group of patients. Method. Case reg isters of adults disabled by long-term mental illness were set up in 1 6 of 110 group general practices asked to participate. A search of eac h practice's record systems was combined with a survey of local psychi atric and social service teams, to seek practice patients who might no t be identified from the general practice data. Results. Of the 440 pa tients found, 90% were identified from information within the practice s, mainly computerized repeat prescription and diagnostic data. The ot her 10% were identified only by psychiatric services. Over one third o f the patients had no current contact with psychiatric services. Patie nts in contact with psychiatric services had been ill for a shorter ti me than those not in contact. More patients suffering from psychotic i llnesses were in current contact than those with non-psychotic diagnos es. Over 90% of the patients had been seen by their general practition ers within 12 months, on average eight times. Most consultations were for minor physical disorders, repeat prescriptions and sickness certif icates. Elements of the formal mental state examination were recorded in one third of cases and adjustments of psychotropic medication in on e fifth. Conclusion. These findings suggest that patients in long-term contact with specialist services cannot be taken as representative of the whole population with long-term mental illness. General practitio ners could use their frequent contacts with long-term mentally ill peo ple to play a greater role in monitoring the mental state and drug tre atment of this group.