Mental health care in general practice: Psychiatry or normal care?
In 2004 Ormel, Bartel and Nolen (2004) formulated the ‘depression paradox’: although evidence based interventions for depression have been developed the past 20 years, the prevalence of depression is not decreasing, it is even increasing for certain subgroups.
Different explanations for this paradoxical development have been put forward. Patients do not look for help. However, part of them do not experience a need for help. Patients who get help are not treated adequately. However, the more severe the disorder, the larger the odds to get adequate help. Moreover, those not treated according to guidelines have comparable remission rates as those treated adequately. Patients who receive adequate treatment are not compliant. However, patients are offered treatment that is not their first choice
To explain the depression paradox, we propose a new conceptualizing in primary mental health care. A clearer distinction is needed between the larger category of psychological problems, expressions of distress etc., that deserves professional attention and guidance and the smaller category of psychiatric disorder, linked to pathophysiological disturbance and in need for evidence based medicine. DSM-IV criteria are not sufficient to make this distinction.
My research program for the following five years will be aimed at a further clarification of this distinction. Main lines of research are the need for psychological help as the patient perceives it, psychological treatments that avoid treatment within a ‘psychiatric’ paradigm, unless needed and cooperation between family medicine and specialized mental health care to realize a proper task division between general psychological care and psychiatric care.
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bijzonder hoogleraar
Tekst in verkorte vorm uitgesproken tijdens de oratie van prof. dr. Peter F.M. Verhaak bij de aanvaarding van het ambt van bijzonder hoogleraar Geestelijke gezondheidszorg in de huisartsvoorziening aan de faculteit der Medische Wetenschappen van de Rijksuniversiteit Groningen
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Verhaak, P. Geestelijke gezondheidszorg in de huisartspraktijk: psychiatriseren of normaliseren?. PSYCHOL. GEZONDH. 39, 94–103 (2011). https://doi.org/10.1007/s12483-011-0020-x
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DOI: https://doi.org/10.1007/s12483-011-0020-x