Psychiatric clinics in primary care

The effect on general practitioner referral patterns
  • G. Strathdee
  • R. M. A. Brown
  • R. J. Doig


A consecutive series of 176 referrals from family doctors to psychiatrists conducting their outpatient clinics im primary care was studied. The presence of psychological symptoms was the stated reason for referral in only half of the patients, although chronic illnesses and the psychotic disorders were well represented. Female sex, attending the GP with physical ill-health and the absence of personality disorder were influential but unacknowledged factors in the referral process. The implications of these findings for the development of community psychiatric services and the relationship between primary and secondary care is discussed.


Public Health Primary Care Outpatient Clinic Chronic Illness Personality Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Beitman BD, Williamson P, Featherstone H, Katon W (1982) Resistance to physician use of the biopsychosocial model. Gen Hosp Psychiatry 4:81–83Google Scholar
  2. Brook A (1978) An aspect of community mental health: consultative work with general practice teams. Health Trends 10:37–39Google Scholar
  3. Brown RMA, Strathdee G, Christie Brown JRW, Robinson PH (1988) A comparison of referrals in primary care and hospital outpatient clinics. Br J Psychiatry 153:168–173Google Scholar
  4. Browning SM, Ford MF, Goddard CA, Brown AC (1987) A psychiatric clinic in general practice; a description and comparison with an outpatient clinic. Bull R Coll Psychiatry 11: 4: 114–117Google Scholar
  5. Carey K, Kogan S (1971) Exploration of factors influencing physician decisions to refer patients to mental health services. Med Care 9:55–66Google Scholar
  6. Carpenter PJ, Morrow GR, Gaudio AC del, Ritzler BA (1981) Who keeps the first outpatient appointment. Am J Psychiatry 138: 1:102–105Google Scholar
  7. Culpepper L (1985) Research on mental health issues in primary care: a primary care perspective. Paper presented at a workshop on Mental Health Liaison in Primary Care. National Institute of Mental Health. October 31, 1985Google Scholar
  8. Eastwood MR, Trevelyan MH (1972) Relationship between physical and psychiatric disorder. Psychol Med 2:363–372Google Scholar
  9. Fink R, Shapiro S (1966) Patterns of medical care relating to mental illness. J Health Hum Behav 7:98–105Google Scholar
  10. Gardiner A, Petersen J, Hall D (1974) A survey of general practitioners' referrals to a psychiatric outpatient service. Br J Psychiatry 124:536–541Google Scholar
  11. Goldberg DP, Blackwell B (1970) Psychiatric illness in general practice. A detailed study using a new method of case identification. Br Med J 2:439–443Google Scholar
  12. Goldensohn S, Fink R, Shapino S (1969) Referral utilisation and staffing patterns for the mental health service in a prepaid group practice programme in New York. Am J Psychiatry 126:689–697Google Scholar
  13. Helgason T (1978) Prevalence and incidence of mental disorders estimated by health questionnaire and a psychiatric case register. Acta Psychiatr Scand 258–266Google Scholar
  14. Hinkle LE, et al. (1960) An explanation of the relation between symptoms, disability and serious illness in two homogeneous groups of men and women. J Publ Health 50:1327–1336Google Scholar
  15. Hopkins P, Cooper B (1969) Psychiatric referral from a general practice. Br J Psychiatry 115:1163–1174Google Scholar
  16. Ingham J, Rawnley K, Hughes D (1972) Psychiatric disorder and its declaration in contrasting areas of South Wales. Psychol Med 2: 281–292Google Scholar
  17. Johnson DAW (1973) A further study of psychiatric outpatient services in Manchester. Br J Psychiatry 122:301–306Google Scholar
  18. Kaeser AC, Cooper B (1971) The psychiatric patient, the general practitioner and the outpatient clinic: an operational study and a review. Psychol Med 1:312–325Google Scholar
  19. Mowbray RM, Blair W, Jubb LG, Clarke A (1961) The general practitioner's attitude to psychiatry. Scot Med J 6:314–321Google Scholar
  20. Orleans CT, George LK, Houpt JL, Brodie HKH (1985) How primary care physicians treat psychiatric disorders: a national survey of family practitioners. Am J Psychiatry 142:52–57Google Scholar
  21. Robertson NC (1979) Variations in referral patterns to the psychiatric services by general practitioners. Psychol Med 9:355–364Google Scholar
  22. Shepherd M, Cooper B, Brown AC, Kalton GW (1966) Psychiatric illness in general practice. Oxford University Press, OxfordGoogle Scholar
  23. Strathdee G (1988) Psychiatrists in primary care: the general practitioner viewpoint. Fam Pract 5:111–115Google Scholar
  24. Strathdee G, Williams P (1984) A survey of psychiatrists in primary care: the silent growth of a new service. J R Coll Gen Pract 34: 615–618Google Scholar
  25. Strathdee G, Williams P (1986) Patterns of collaboration. In: Shepherd M, Wilkinson G, Williams P (eds) Mental Illness in Primary Care Settings. London. Tavistock Press, London, pp 139–168Google Scholar
  26. Tyrer P (1984) Psychiatric clinics in general practice. An extension of community care. Br J Psychiatry 145:9–14Google Scholar
  27. Weissman M, Klerman G (1977) Sex differences in the epidemiology of depression. Arch Gen Psychiatry 34:98–111Google Scholar
  28. World Health Organisation (1973) Psychiatry and Primary Medical Care 1973. WHO Regional Office for Europe, CopenhagenGoogle Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • G. Strathdee
    • 1
  • R. M. A. Brown
    • 2
  • R. J. Doig
    • 3
  1. 1.Greenwich District Health AuthorityMemorial HospitalLondonEngland
  2. 2.Institute of PsychiatryLondonEngland
  3. 3.Hither Green HospitalLondonEngland

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