Referral for minor mental illness: a qualitative study.
BACKGROUND
Mild depression and anxiety are common problems in general practice. They can be managed by the general practitioner (GP) alone or referred. Previous quantitative studies have shown a large variation between GPs in terms of referral behaviour. The reasons for this variation are not fully understood.


OBJECTIVE
To describe and analyse GP's decision-making processes when considering who should be treating patients with minor mental illness, using a qualitative method.


METHODS
A qualitative interview study.


METHODS
Twenty-three GPs in east London and Essex.


METHODS
Subjects were chosen using a purposive sampling strategy and participated in one-to-one semi-structured interviews. A grounded theory approach was used for analysis.


RESULTS
Two distinct referral strategies were identified--the 'containment' and the 'conduit' approaches. In addition, referrals were found to be of two types--proactive 'referrals to' and reactive 'referrals away'; for minor mental illness the 'referrals away' were found to predominate. Emotive as well as rational responses informed GP decision making on referral.


CONCLUSIONS
Explanations of the variation in referral rates need to recognise the emotive responses of individual GPs to minor mental illness. The contribution of guidelines, which assume consistently rational responses to illness, may therefore be limited.
Nandy
S
S
Department of General Practice and Primary Care, St Bartholomew's and Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS.
Chalmers-Watson
C
C
Gantley
M
M
Underwood
M
M
D000328:Adult; D003657:Decision Making; D005194:Family Practice / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D010817:Physician-Patient Relations; D012017:Referral and Consultation / Q000706:statistics & numerical data*