A qualitative study of referral to community mental health teams in the UK: exploring the rhetoric and the reality.
BACKGROUND
Generic community mental health teams (CMHTs) currently deliver specialist mental health care in England. Policy dictates that CMHTs focus on those patients with greatest need but it has proved difficult to establish consistent referral criteria. The aim of this study was to explore the referral process from the perspectives of both the referrers and the CMHTs.


METHODS
Qualitative study nested in a randomised controlled trial. Interviews with general practitioner (GP) referrers, CMHT Consultant Psychiatrists and team leaders. Taping of referral allocation meetings.


RESULTS
There was a superficial agreement between the referrers and the referred to on the function of the CMHT, but how this was operationalised in practice resulted in a lack of clarity over the referral process, with tensions apparent between the views of the referrers (GPs) and the CMHT team leaders, and between team members. The process of decision-making within the team was inconsistent with little discussion of, or reflection on, the needs of the referred patient.


CONCLUSIONS
CMHTs describe struggling to deal with GPs who are perceived as having variable expertise in managing patients with mental health problems. CMHT rhetoric about defined referral criteria is interpreted flexibly with CMHT managers and Psychiatrists concentrating on their own capacity, roles and responsibilities with limited consideration of the primary care perspective or the needs of the referred patient.


BACKGROUND
ISRCTN86197914.
Chew-Graham
Carolyn
C
School of Community Based Medicine, University of Manchester, Rusholme Academic Unit, Manchester, UK. cchew@manchester.ac.uk
Slade
Mike
M
Montana
Carolyn
C
Stewart
Mairi
M
Gask
Linda
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D003659:Decision Making, Organizational; D004739:England; D005194:Family Practice / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011570:Psychiatry / Q000458:organization & administration; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012962:Sociology, Medical; D011795:Surveys and Questionnaires