Consultations for mental problems in general practices with and without mental health nurses.

Background & Aim: It seems cost-effective to provide mental health care to patient with mild mental problems in general practices instead of in specialized care, but general practitioners (GPs) often lack time or expertise. Since 2008, Dutch GPs have been collaborating with nurses with mental health expertise. Mental health nurses perform diagnostic tests and provide short term care. It is not clear yet if mental health nurses replace GP care, or if they provide additional care. The aim of this study was to investigate a possible transition of care from GPs to mental health nurses. Method: in an observational study, we analyzed consultation data routinely recorded in Dutch general practices participating in NIVEL Primary Care Database (NIVEL-PCD) between 2010 and 2014. We used multilevel regression models to analyze consultations for mental problems at GPs and mental health nurses. We compared consultations for mental problems between general practices with and without mental health nurse. Results: Increasing numbers of Dutch general practices collaborate with a mental health nurse; from 20% in 2010 to 83% in 2014. Increasing numbers of patients have at least one consultation for mental problems in general practice. Mental health nurses most often provide care to adult, female patients with common psychological symptoms, during on average three long consultations. GPs working in practices with a mental health nurse treat slightly more patients with mental problems than GPs without a mental health nurse (OR=1.05; 95%CI=1.02-1.08), but they use comparable numbers of consultations per patient. Conclusions: Mental health nurses do not seem to replace GP care, but mainly provide additional consultations to patients with mental problems. Collaboration with a mental health nurse may increase GPs’ skills to recognize mental problems. Future research should learn to what extent (early) treatment by mental health nurses prevents patients from needing specialized care