Towards more appropriate care for patients on a waiting list for mental health care: a study on good practices to prevent and mitigate the risks of bridging care in general practices

Background and relevance

The prevalence of mental health problems and the demand for professional support is increasing. For several years, the accessibility of Dutch mental health care has been under serious pressure. As a result, general practices cannot properly fulfill their role as gatekeepers and referrers. Patients referred by general practitioners (GPs) to mental health care are often placed on a waiting list; for months or sometimes even for years. At the end of 2022, 84,000 people were on a waiting list for mental health care, and 51% of them were waiting longer than the maximum of 14 weeks that is acceptable according to the norms agreed upon within the field. Many of the patients that are on a waiting list receive general practice care in the meantime. GPs and general practice mental health professionals (GP-MHPs) are forced to provide care to patients with mental health problems who actually need more specialized care. As a result, they have less room to provide low-threshold support to patients with mild psychological problems.

Problem definition and objectives

Bridging care for patients on a waiting list for mental health care is not the responsibility of GPs, does not seem to fit within the framework of general practice care and therefore entails risks, both for patients and relatives and for professionals in general practice.

Objectives of this project are:

1. to systematically map the risks of bridging care in general practices, both for adult patients with mental health problems and relatives and for professionals in general practice.
2. to systematically identify and test good practices that contribute to preventing and reducing the risks of bridging care.

Plan of approach

In this one-year project, desk research and a field consultation with online questionnaires among patients and relatives, general practice professionals and experts/researchers are used to map the risks of bridging care for adult patients with mental health problems and professionals in general practices. We identify good practices to prevent and mitigate these risks and systematically describe and test them in collaboration with a stakeholder advisory committee (using a common framework, systematic mapping, and an online Delphi study).

Study objects

Inclusion criteria for good practices are: interventions that (potentially) contribute to preventing and reducing the risks of bridging care, target group adult patients with mental health problems, implemented in at least 1 region in the Netherlands. No exclusion criteria for good practices are applied (yet).

Intended results

The project provides an overview of good practices for preventing and reducing the risks of bridging care for patients with mental health problems, and provides useful tools for care professionals in general practices.

Impact

We disseminate results through a factsheet for patients and caregivers, through articles in professional journals, and through future revisions of clinical guidelines and policy documents. Ultimately, we want to contribute to more appropriate care for patients with mental health problems and less pressure on general practices.

Diversity

Diversity aspects such as age, gender and socioeconomic status (SES) are related to the prevalence of mental health problems and to access to mental health care. During this project, attention is paid to nine specific patient groups who are at an increased risk of developing mental health problems and/or experience limited accessibility to mental health care.