Improving primary mental health care: impact of a nationwide programme.

OBJECTIVE: To determine the impact of a nationwide programme on primary mental health care practices. DESIGN: Cohort study involving two surveys conducted in 2001 and 2003. SETTING AND SUBJECTS: Random sample of 2757 general practitioners. INTERVENTION: In 2001, a nationwide programme was initiated to improve primary mental health care. The programme used a participatory approach with regional needs assessment and regional selection of the interventions. MAIN OUTCOME MEASURES: Perceived need, availability and participation in the interventions; self-reported mental health performance (self-reported diagnosis and management of mental health disorders); perceived barriers to optimal care. RESULTS: Baseline and follow-up questionnaires were returned by 1336 and 1358 general practitioners, respectively. Interventions did not entirely match general practitioners' needs. Mental health performance did not change consistently while perceived barriers to optimal care decreased considerably. Actual participation in the interventions was not associated with improved mental health performance or decreased perception of barriers. CONCLUSIONS: The application of the nationwide programme had no considerable impact on the professional practices of general practitioners with regard to mental health care. This finding challenges the assumption that a bottom-up approach to quality improvement is effective. Extensive coordination at a national level and the provision of specific supportive products and services appears to be necessary to achieve improvement