The evaluation of a mental health facilitator in general practice: effectson recognition, management, and outcome of mental illness

Background. Facilitation uses personal contact between the facilitator and the professional to encourage good practice and better service organisation . The model has been applied to physical illness but not to psychiatric dis orders. Aim. To determine if a non-specialist facilitator can improve the recogniti on, management, and outcome of psychiatric illness presenting to general pr actitioners (GPs). Method Six practices were visited over an 18-month period by a facilitator whose activities included providing guidelines and organising training init iatives. Six of her practices acted as controls. Recognition (identificatio n index of family doctors), management (psychotropic prescribing, psycholog ical consultations with the GP, specialist mental health treatment, and the use of medical interventions and investigations), and patient outcome at f our months were assessed before and after intervention. Results. The mean identification index of facilitator GPs rose from 0.51 to 0.64 following intervention, while that of the control GPs fell from 0.67 to 0.59 (P = 0.046). The facilitator had no detectable effect on management or patient outcome. Conclusions. The facilitator improved recognition of psychiatric illness by GPs. Generic facilitators can be trained to take on a mental health role; however, the failure to achieve more fundamental changes in treatment and o utcome implies that facilitator intervention requires development.