title: Which patients are seen by an occupational psychiatry service?
abstract: BACKGROUND
  Common mental disorders are the leading cause of sickness absence but are frequently misdiagnosed and undertreated. It is against this background that a specialist occupational psychiatry clinic was established at a London teaching hospital.
  
  
  OBJECTIVE
  To explore the nature of patients and complaints seen in the clinic and investigate whether this form of service provision reached patients who may have otherwise been missed in the gap between primary and secondary care.
  
  
  METHODS
  We reviewed the case notes of 51 consecutive new clinic assessments using a data extraction form, gathering information on socio-demographic and occupational details; the nature, duration and severity of symptoms [as assessed by Health of the Nation Outcome Scale (HoNOS)]; diagnosis; prior treatment and the outcome of the clinic appointment.
  
  
  RESULTS
  Only half of those seen in the new clinic were currently on sick leave. The most common diagnosis was depression with most having symptoms lasting longer than 9 months. Sixty-five per cent had a medium or high HoNOS rating. Although 75% had received treatment from their general practitioner, the majority remained functionally impaired, and only 31% had been seen in secondary care.
  
  
  CONCLUSIONS
  Specialist occupational psychiatry clinics do not replicate the work already being done by standard mental health services. Patients referred to a new specialist clinic within an occupational health department had chronic, debilitating psychiatric illnesses, which in many cases had failed to respond adequately to primary care treatment and were at risk of falling into the gap between primary and secondary services.
authors.affiliation: King's College London, Institute of Psychiatry, Weston Education Centre, London SE5 9RJ, UK.
authors.forename: S
authors.initials: S
authors.lastname: Burman-roy
authors.forename: M
authors.initials: M
authors.lastname: Butterworth
authors.forename: I
authors.initials: I
authors.lastname: Madan
authors.forename: M
authors.initials: M
authors.lastname: Henderson
authors.forename: S B
authors.initials: SB
authors.lastname: Harvey
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D003695:Delivery of Health Care; D003863:Depression / Q000453:epidemiology* / Q000628:therapy; D003866:Depressive Disorder / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D009786:Occupational Health Services; D011320:Primary Health Care; D011570:Psychiatry; D012189:Retrospective Studies; D063127:Secondary Health Care; D018582:Sick Leave; D055815:Young Adult
keywords: Anxiety; depression; mental health; occupational psychiatry; service evaluation; work stress.; workplace mental health