Mental health care in general practice in the context of a system reform.

The aim of this thesis was to monitor mental health care in Dutch general practices in recent years. In 2014, a reform of the Dutch mental health care system was introduced. Since this reform, general practitioners (GPs) are expected to only refer patients with a (suspected) psychiatric disorder or at high risk for (self) harm. All other patients with mental health problems should be treated within general practice. Treatment in general practice is highly accessible for patients, and less expensive than specialized care. To be able to treat more patients with mental health problems, the majority of the GPs now collaborate with a mental health nurse. The main tasks of mental health nurses are to clarify the problems of patients, and to support them during a small number of consultations. Since the introduction of mental health nurses, increasing numbers of patients with mental health problems receive treatment within general practice. So far, no task shifting from GPs to mental health nurses has been observed. Mental health nurses provide additional care to patients who previously probably would not have received any treatment or who would have been referred immediately. GPs’ antidepressants prescriptions did not decrease in recent years, despite the fact that mental health nurse support can be an alternative to medication for some patients. The care for patients with mental health problems seems to place a large burden on general practitioners and mental health nurses. Therefore, mental health care in general practice should be continuously monitored. (aut. ref.