Five levels and four filters: a personal reflection on the Pathways to Psychiatric Care

Linda Gask

doi:10.1921/swssr20252507

Authors

Linda Gask Retired https://orcid.org/0000-0002-7918-3967

DOI:

https://doi.org/10.1921/swssr20252507

Keywords:

pathways, epidemiology, referral, mental health, primary care, secondary care

Abstract

In this personal reflection on Goldberg and Huxley’s seminal Pathways to Care model, the author considers how it has provided a framework for research she has carried out during her career in primary care mental health. The levels described in the model are not only of epidemiological significance, but also represent the, quite different, ‘worlds’ encountered within mental health care. The filters are the sites at which negotiation is required to pass through (in either direction) and where quality of communication becomes paramount.

Author Biography

Linda Gask, Retired

Linda Gask is retired from clinical work, she lives in Orkney, writes memoir and non-fiction and is Chair of the islands’ only third sector dedicated mental health organisation. ORCID: https://orcid.org/0000-0002-7918-3967

References

Bebbington, P.E., Meltzer, H., Brugha, T.S., Farrell, M., Jenkins, R., Ceresa, C. and Lewis, G. (2000) Unequal access and unmet need: neurotic disorders and the use of primary care services. Psychological Medicine, 30, 6, 1359-1367.

Bhui, K. and Bhugra, D. (2002) Mental illness in Black and Asian ethnic minorities: pathways to care and outcomes. Advances in Psychiatric Treatment, 8, 1, 26-33.

Byng, R., Creanor, S., Jones, B., Hosking, J., Plappert, H., Bevan, S., Britten, N., Clark, M., Davies, L., Frost, J., Gask, L., Gibbons, B., Gibson, J., Hardy, P., Hobson-Merrett, C., Huxley, P., Jeffery, A., Marwaha, S., Rawcliffe, T., Reilly, S., Richards, D., Sayers, R., Williams, L., Pinfold, V. and Birchwood, M. (2023) The effectiveness of a primary care-based collaborative care model to improve quality of life in people with severe mental illness: PARTNERS2 cluster randomised controlled trial. The British Journal of Psychiatry, 222, 6, 246-256. https://doi.org/10.1192/bjp.2023.28

Campbell, S.M., Roland, M.O. and Buetow, S.A. (2000) Defining quality of care. Social Science & Medicine, 51, 11, 1611-1625.

Cape, J., Whittington, C. and Bower, P. (2010) What is the role of consultation–liaison psychiatry in the management of depression in primary care? A systematic review and meta-analysis. General Hospital Psychiatry, 32, 3, 246-254.

Chew-Graham, C., Slade, M., Montana, C., Stewart, M. and Gask, L. (2007) A qualitative study of referral to community mental health teams in the UK: exploring the rhetoric and the reality. BMC Health Services Research, 7, 1, 1-9.

Coventry, P., Lovell, K., Dickens, C., Bower, P., Chew-Graham, C., McElvenny, D., Hann, M., Cherrington, A., Garrett, C., Gibbons, C.J., Baguley, C., Roughley, K., Adeyemi, I., Reeves, D., Waheed, W. and Gask, L. (2015) Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease. bmj, 350.

Creed, F. and Marks, B. (1989) Liaison psychiatry in general practice: a comparison of the liaison-attachment scheme and shifted outpatient clinic models. The Journal of the Royal College of General Practitioners, 39, 329, 514-517.

Davenport, S., Goldberg, D. and Millar, T. (1987) How psychiatric disorders are missed during medical consultations. The Lancet, 330, 8556, 439-441.

Dixon-Woods, M., Cavers, D., Agarwal, S., Annandale, E., Arthur, A., Harvey, J., Hsu, R., Katbamna, S., Olsen, R., Smith, L. and Riley, R. (2006) Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Medical Research Methodology, 6, 1-13.

Dowrick, C. and Buchan, I. (1995) Twelve month outcome of depression in general practice: does detection or disclosure make a difference? BMJ, 311, 7015, 1274-1276.

Dowrick, C., Chew-Graham, C., Lovell, K., Lamb, J., Aseem, S., Beatty, S., Bower, P., Burroughs, H., Clarke, P., Edwards, S., Gabbay, M., Gravenhorst, K., Hammond, J., Hibbert, D., Kovandžic ́, M., Lloyd-Williams, M., Waheed, W. and Gask, L. (2013) Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study. Programme Grants for Applied Research, 1, 2.

Gask, L. and Goldberg, D. (1993) Impact on patient care, satisfaction and clinical outcome of improving the psychiatric skills of general practitioners. The European Journal of Psychiatry, 7, 4, 203-218.

Gask, L., Goldberg, D.P., Lesser, A.L. and Millar, T. (1988) Improving the psychiatric skills of the general practice trainee: an evaluation of a group training course. Medical Education, 22, 2, 132-138.

Gask, L., Dowrick, C., Dixon, C., Sutton, C., Perry, R., Torgerson, D. and Usherwood, T. (2004) A pragmatic cluster randomized controlled trial of an educational intervention for GPs in the assessment and management of depression. Psychological Medicine, 34, 1, 63-72.

Gask, L., Bower, P., Lamb, J., Burroughs, H., Chew-Graham, C., Edwards, S., Hibbert, D., Kovandžić, M., Lovell, K., Rogers, A. and Waheed, W. (2012) Improving access to psychosocial interventions for common mental health problems in the United Kingdom: narrative review and development of a conceptual model for complex interventions. BMC Health Services Research, 12, 1-13.

Gask, L., Kendrick, T., Peveler, R. and Chew-Graham, C. A. (Eds.) (2018) Primary Care Mental Health. Cambridge: Cambridge University Press.

Gater, R., Tomenson, B., Percival, C., Chaudhry, N., Waheed, W., Dunn, G., Macfarlane, G. and Creed, F. (2009) Persistent depressive disorders and social stress in people of Pakistani origin and white Europeans in UK. Social Psychiatry and Psychiatric Epidemiology, 44, 198-207.

Gilbody, S., Whitty, P., Grimshaw, J. and Thomas, R. (2003) Educational and organizational interventions to improve the management of depression in primary care: a systematic review. JAMA, 289, 23, 3145-3151.

Goldberg, D. and Goodyer, I. M. (2014) The Origins and Course of Common Mental Disorders. London: Routledge.

Goldberg, D. and Huxley, P (1980) Mental Illness in the Community: The pathway to psychiatric care. London: Routledge.

Goldberg, D.P., Jenkins, L., Millar, T. and Faragher, E.B. (1993) The ability of trainee general practitioners to identify psychological distress among their patients. Psychological Medicine, 23, 1, 185-193.

Johnstone, A. and Goldberg, D. (1976) Psychiatric screening in general practice: a controlled trial. The Lancet, 307, 7960, 605-608.

McEvoy, P., Williamson, T., Kada, R., Frazer, D., Dhliwayo, C. and Gask, L. (2017) Improving access to mental health care in an Orthodox Jewish community: a critical reflection upon the accommodation of otherness. BMC Health Services Research, 17, 1, 1-15.

Meltzer, H., Bebbington, P., Brugha, P., Farrell, M., Jenkins, R. and Lewis, G. (2000) The reluctance to seek treatment for neurotic disorders. Journal of Mental Health, 9, 3, 319-327.

Morriss, R., Dowrick, C., Salmon, P., Peters, S., Dunn, G., Rogers, A., Lewis, B., Charles-Jones, H., Hogg, J., Clifford, R. and Rigby, C. (2007) Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms. The British Journal of Psychiatry, 191, 6, 536-542.

Raine, R., Carter, S., Sensky, T. and Black, N. (2005) Referral into a Void’: Opinions of General Practitioners and Others on Single Point of Access to Mental Health Care. Journal of the Royal Society of Medicine, 98, 4, 153-157.

Richards, D.A., Hill, J.J., Gask, L., Lovell, K., Chew-Graham, C., Bower, P., Cape, J., Pilling, S., Araya, R., Kessler, D. and Bland, J.M. (2013) Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial. BMJ, 347.

Unützer, J., Katon, W., Callahan, C.M., Williams Jr, J.W., Hunkeler, E., Harpole, L., Hoffing, M., Della Penna, R.D., Noël, P.H., Lin, E.H. and Areán, P.A. (2002) Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA, 288, 22, 2836-2845.

Üstün, T. B. and Sartorius, N. (Eds.) (1995) Mental Illness in General Health Care: An international study. Chichester: John Wiley & Sons.