Comparison of integrated and consultation-liaison models for providing mental health care in general practice in New South Wales, Australia

The characteristics of a new service providing integrated mental health car e in general practice are described and comparisons made with an earlier co nsultation-liaison (C-L) psychiatry service in general practice, including the range and severity of psychiatric problems, levels of general practitio ner (GP) and psychiatrist involvement, and patterns of care. Clinical audit checklists were completed by two experienced mental health nurses for the first 100 patients referred to the service, which was conducted in conjunct ion with 8 general practices in the Port Stephens region of New South Wales , Australia. The mean age of the first 100 referrals was 38.05 years, 63.0% were female, and 55.0% were referred from GPs. Outcome measures included: referral information, patients' demographic and diagnostic characteristics, psychosocial functioning, psychotropic medication, management, and number of contacts with the mental health nurses. Relative to the earlier C-L psyc hiatry service in general practice, the integrated service treated a broade r range of diagnostic groups with higher levels of disability. There were h igher rates of mood (48.0%) and psychotic (20.0%) disorders and lower rates of adjustment (2.0%) disorders. One-third of patients were seen by an addi tional agency, other than the mental health nurses or GPs. Patients average d 4.95 contacts with the mental health nurses, with marked variations accor ding to diagnostic group. To date, the new service has been well received. It is highly accessible, acceptable to GPs and patients, caters for a broad range of psychopathology, including severe mental illness, and appears to be sufficiently versatile to be adaptable to a variety of treatment setting s.