Are specialist mental health services being targeted on the most needy patients? The effects of setting up special services in general practice

Background. Around 25% of patients with psychoses lose contact with special ist psychiatric services, despite the government's policy to focus the effo rts of community teams on this group. Aim. To identify patient and practice factors associated with continuing co ntact and loss of contact with specialist services. Method. Cross-sectional comparison was made of patients in and out of speci alist contact, through detailed interviews with 102 patients among 26 south west London practices. Associations were sought between contact with speci alist services and patient factors (illness severity, social functioning, q uality of life, needs for care, and satisfaction with general practitioner [GP] services) and practice factors (size, location, fundholding status, tr aining status, and the presence of mental health professionals on site). Results. Thirty-one (30%) patients were currently out of specialist contact . No significant differences were found between those in and out of contact an any measures of diagnosis or psychiatric history. Those in contact had significantly more symptoms, poorer social functioning, poorer quality of l ife, and more needs for care. The proportion out of contact was significant ly higher in two practices that had employed their own mental health profes sionals to provide services on site for severe mental illnesses. Two factor s remained significant predictors of contact in a logistic regression model : whether or not the patient's practice offered a special service on site, and greater patient needs for care. Conclusions. Secondary mental health services are being targeted towards th e more needy patients. The provision of special services in practices can s hift care further away from secondary care while still meeting patients' ne eds.