'Please see and advise': a qualitative study of patients' experiences of psychiatric outpatient care

Background: Patient evaluations have become a sensitive indicator of servic e delivery and the quality of care. In this study they paint to a lack of c larity surrounding the role of outpatient psychiatry in relation to primary care, raising questions about the effective integration of services for pa tients whose needs straddle the boundaries of primary and specialist care.; Methods: Interviews with a consecutive series of 100 new referrals to two o utpatient clinics compared their expectations of treatment with their subse quent experiences of psychiatric care. Patients' perception of progress was compared with clinical assessments. Follow-up interviews explored the reas ons why patients tended to lapse from care. Results: The majority of patien ts (74%) hoped for more effective responses to often long-standing problems which had previously been treated with limited success. In approximately o ne-third of cases this expectation was met; the remainder reported psychiat ric intervention was less than helpful (20%), or were unable to say whether it had helped or not. Most of these patients perceived little difference b etween psychiatric supervision and treatment offered by their GP. Seemingly impersonal consultations and failure to engage with underlying problems co ntributed to the high drop-out rate. Conclusion: The findings indicate a re latively poor fit between the role of the outpatient service and the circum stances that commonly lead to psychiatric referral. The implications are co nsidered in relation to alternative options for managing psychosocial probl ems within primary care.