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

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Abstract

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.

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Acknowledgments

The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The World Health Organization World Mental Health (WMH) Survey Initiative is supported by the National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline and Bristol-Myers Squibb. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork and consultation on data analysis. The work of the MSU-based authors (LD, HC, JCA) in preparing this report was additionally supported by the National Institute on Drug Abuse (K05DA015799; R01DA016558), while the work of LD was funded by an Australian NHMRC Senior Research Fellowship. Financial support was also received from French CNAM-TS (Caisse Nationale d’Assurance Maladie des Travailleurs Salariés [French National Public Health Insurance for Employees]). None of the funders had any role in the design, analysis, interpretation of results or preparation of this paper. The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of the sponsoring organizations, agencies or governments. A complete list of all within-country and cross-national WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.

Conflict of interest

The authors have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. EA4069 Ecole des Hautes Etudes en Santé Publique (EHESP), Hôtel Dieu, Paris Descartes University, Sorbonne Paris Cité, 1 place du parvis de Notre-Dame, 75181, Paris Cedex 04, France

    Anne Dezetter & V. Kovess-Masféty

  2. CERMES3-CESAMES, Paris Descartes University, Sorbonne Paris Cité, Paris, France

    Anne Dezetter & X. Briffault

  3. Universitair Psychiatrisch Centrum-Katholieke Universiteit Leuven (campus Leuven), Leuven, Belgium

    R. Bruffaerts

  4. Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands

    R. De Graaf

  5. Health Services Research Unit, Municipal Institute of Medical Research (IMIM), Barcelona, Spain

    J. Alonso & G. Vilagut

  6. Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    H. H. König

  7. Servies de Salut Mental, Sant Joan de Déu, Sant Boi de Loobregat, Barcelona, Spain

    J. M. Haro

  8. Department of Mental Health, Azienda Unita, Sanitaria Locale di Bologna, Bologna, Italy

    G. de Girolamo

Authors
  1. Anne Dezetter
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  2. X. Briffault
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  3. R. Bruffaerts
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  4. R. De Graaf
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  5. J. Alonso
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  6. H. H. König
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  7. J. M. Haro
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  8. G. de Girolamo
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  9. G. Vilagut
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  10. V. Kovess-Masféty
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Corresponding author

Correspondence to Anne Dezetter.

Appendix

Appendix

Questions about use of GPs and MHPs

Lifetime use of professionals

The next question is about speaking with professionals about problems with emotions or mental health. By “professionals” we mean medical doctors, nurses, psychologists, social workers, spiritual advisors, herbalists and any other healing professionals. With this definition in mind, did you ever in your life talk to a medical doctor or other professionals about any problem with your emotions or mental health?

Did you ever in your life talk to any of the following types of professionals about problems with your emotions or mental health:

  • a psychiatrist?

  • any other mental health professional, such as a psychologist, psychotherapist, social worker or counselor?

  • a general family doctor?

  • any other doctor, like a cardiologist or (women: gynecologist/men: urologist)?

  • any other health professional, like a nurse or a nutritionist?

  • a religious or spiritual advisor like a minister, priest or rabbi?

  • any other healer, like a herbalist, chiropractor or spiritualist?

Use during the 12-month period

Each professional section gets this question:

When was the last time—in the past months, 2–6 months ago, 7–12 months ago, or more than 12 months ago?

Being referred by a GP

Did a family doctor ever refer you to a mental health specialist, clinic or program?

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Dezetter, A., Briffault, X., Bruffaerts, R. et al. Use of general practitioners versus mental health professionals in six European countries: the decisive role of the organization of mental health-care systems. Soc Psychiatry Psychiatr Epidemiol 48, 137–149 (2013). https://doi.org/10.1007/s00127-012-0522-9

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