title: Referral for minor mental illness: a qualitative study.
abstract: 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.
authors.affiliation: 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.
authors.forename: S
authors.initials: S
authors.lastname: Nandy
authors.forename: C
authors.initials: C
authors.lastname: Chalmers-Watson
authors.forename: M
authors.initials: M
authors.lastname: Gantley
authors.forename: M
authors.initials: M
authors.lastname: Underwood
mesh_terms: 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*