The evaluation of a mental health facilitator in general practice: effects on recognition, management, and outcome of mental illness.
BACKGROUND
Facilitation uses personal contact between the facilitator and the professional to encourage good practice and better service organisation. The model has been applied to physical illness but not to psychiatric disorders.


OBJECTIVE
To determine if a non-specialist facilitator can improve the recognition, management, and outcome of psychiatric illness presenting to general practitioners (GPs).


METHODS
Six practices were visited over an 18-month period by a facilitator whose activities included providing guidelines and organising training initiatives. Six other practices acted as controls. Recognition (identification index of family doctors), management (psychotropic prescribing, psychological consultations with the GP, specialist mental health treatment, and the use of medical interventions and investigations), and patient outcome at four months were assessed before and after intervention.


RESULTS
The mean identification index of facilitator GPs rose from 0.51 to 0.64 following intervention, while that of the control GPs fell from 0.67 to 0.59 (P = 0.046). The facilitator had no detectable effect on management or patient outcome.


CONCLUSIONS
The facilitator improved recognition of psychiatric illness by GPs. Generic facilitators can be trained to take on a mental health role; however, the failure to achieve more fundamental changes in treatment and outcome implies that facilitator intervention requires development.
Bashir
K
K
University Department of Psychiatry, Royal Free Hospital School of Medicine, London.
Blizard
B
B
Bosanquet
A
A
Bosanquet
N
N
Mann
A
A
Jenkins
R
R
D000488:Allied Health Personnel / Q000706:statistics & numerical data; D019090:Case Management / Q000458:organization & administration*; D002983:Clinical Competence; D005194:Family Practice / Q000592:standards*; D006801:Humans; D007400:Interprofessional Relations; D008131:London; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy; D017008:Negotiating; D010348:Patient Care Team / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000379:methods; D016896:Treatment Outcome