Use of general practitioners versus mental health professionals in six European countries: the decisive role of the organization of mental health-care systems

• Published in: Social Psychiatry and Psychiatric Epidemiology 2013, Vol.48 (1), p.137-149
• Main Authors: Dezetter, Anne, Briffault, X., Bruffaerts, R., De Graaf, R., Alonso, J., König, H. H., Haro, J. M., de Girolamo, G., Vilagut, G., Kovess-Masféty, V.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anxiety disorders; Biological and medical sciences; Collaboration; Community Mental Health Services - statistics & numerical data; Community Mental Health Services - utilization; Cross-Cultural Comparison; Cross-Sectional Studies; Delivery of Health Care - organization & administration; Epidemiology; Europe - epidemiology; Female; General Practitioners; Health care access; Health services; Health Surveys; Humans; Institutionalization; Interviews; Life Sciences; Logistic Models; Male; Medical personnel; Medical research; Medical sciences; Medicine; Medicine & Public Health; Medicine, Experimental; Mental disorders; Mental Disorders - epidemiology; Mental Disorders - therapy; Mental health; Mental health care; Mental illness; Middle Aged; National Health Programs - organization & administration; Organization of mental health. Health systems; Original Paper; Physicians; Physicians (General practice); Prevalence; Primary Health Care - statistics & numerical data; Primary Health Care - utilization; Professionals; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotherapy; Reimbursement; Santé publique et épidémiologie; Social psychiatry. Ethnopsychiatry; Sociodemographics; Socioeconomic Factors; Surveys; Surveys and Questionnaires; Young Adult
• ISSN: 0933-7954; 1433-9285
• DOI: 10.1007/s00127-012-0522-9

Objective To investigate patterns of use of general practitioners (GPs) and/or mental health professionals (MHPs) for mental health reasons, across six European countries, and the extent to which these patterns of use are associated with differences in mental health-care delivering systems. Methods Data are based on the European Study of the Epidemiology of Mental Disorders (ESEMeD): a cross-sectional survey of a representative sample of 8,796 non-institutionalized adults from six European countries, conducted between 2001 and 2003 using computer-assisted interviews with the CIDI-3.0. Countries were classified into: MHP− for countries where access to medical professionals tends to predominate (Belgium, France, Italy), and MHP+ where access to non-medical MHPs predominates (Germany, Spain, The Netherlands). Results Among respondents consulting GPs and/or MHPs in the past year ( n  = 1,019), respondents from the MHP− group more often consulted GPs (68 vs. 55 % in MHP+ group), GPs and psychiatrists (23 vs. 14 %). People from the MHP+ group more often used MHPs only (45 vs. 32 %), GPs and non-medical MHPs (16 vs. 8 %). GPs from the MHP+ group were more inclined to refer patients to MHPs. Factors associated with use of GPs versus MHPs were: being over 49 years, not highly educated, lower income and suffering from mood or severe mental disorders. Conclusions Differences in the use of GPs versus MHPs are markedly linked to individual as well as organizational factors. Interventions are needed, in countries fostering medical access, to reimburse sessions with non-medical MHPs and improve cooperation between professionals to obtain better practice in access to care.