title: Attitudes of GPs towards Older Adults Psychology Services in the Scottish Highlands.
abstract: BACKGROUND
  The mental health of older adults is of increasing concern in an aging population and GPs are frequently the gatekeepers to specialist mental health services. Psychotherapy, social interventions and bibliotherapy all have an evidence-base for treating depression and anxiety in the elderly, as does pharmacological treatment. However, the referral rate from GPs for an Older Adults Clinical Psychology service in the Scottish Highlands in the months prior to the study had been very low and the reasons for this were not clear. General practitioners may have felt that depression and anxiety are 'understandable' in older adults and are therefore unsuitable for treatment, or they may have felt that psycho-pharmacotherapy treatments are more effective than the psychotherapy treatment options. Alternatively, local issues associated with the remote location of many NHS Highland GP practices and patients may have prevented them referring. Therefore, the current study aimed to elicit the therapeutic preferences of Highland GPs, the perceived availability of these options and an estimate of the prevalence of older adults in the area suffering from mild or moderate mental health problems.
  
  
  METHODS
  Questionnaires including brief quantitative and qualitative questions were sent to all 284 GPs in the area with 119 (46%) were completed and returned.
  
  
  RESULTS
  Responses from GPs suggested that many patients with depression or anxiety may not be referred. The GPs indicated that social therapeutic options are seen to be as effective as pharmacological options and more effective than other psychological and bibliotherapy options. However, GPs indicated that they were substantially more likely to prescribe pharmacological options than other forms of therapy. The GPs suggested that lower waiting times and a more localised service would increase the likelihood of a referral being made.
  
  
  CONCLUSIONS
  The current study suggests that low awareness of psychological service provision among GPs may have resulted in fewer referrals, rather than low confidence in psychotherapies for this population. The GPs' preference for social interventions may reflect the particular risk of isolation of the elderly in remote communities and may be worthy of consideration when developing services in these areas.
authors.affiliation: NHS Highland Department of Psychological Services, New Craigs Hospital, Inverness, Scotland. Jonathan.Todman@ggc.scot.nhs.uk
authors.forename: Jonathan P F
authors.initials: JP
authors.lastname: Todman
authors.forename: Jim
authors.initials: J
authors.lastname: Law
authors.forename: Andrew
authors.initials: A
authors.lastname: MacDougall
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000628:therapy*; D001291:Attitude of Health Personnel; D003863:Depression / Q000175:diagnosis / Q000628:therapy*; D058005:General Practitioners; D006297:Health Services Accessibility / Q000458:organization & administration; D006299:Health Services for the Aged / Q000458:organization & administration; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration*; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D012017:Referral and Consultation / Q000458:organization & administration*; D012424:Rural Population; D012606:Scotland; D013222:State Medicine