Roles for Professionals
Whilst the clinical pathways shown previously in this document identify professionals to undertake specific roles this will be dependent on local availability. No professional should take on any role for which they have not received training or which they do not feel competent to undertake.
The following recommendations may be useful:
GPs
- Initial assessment
- Patient education
- Initial medication prescription
- Case management (as an interim arrangement only)
Practice Nurse, graduate worker
- Screening
- Patient education
- Follow up and monitoring of progress
- Guided self-help
- Signposting
- Group psycho-education
- Assisting with CCBT
- Case management in moderate to severe depression
Primary Care Mental Health Professionals, Counsellors
- Brief CBT
- Brief Counselling
Gateway workers, PwSi, GPwSI, CPN
- Supervision for primary care clinicians
- Training for primary care clinicians in the recognition and management of depression
- Strengthening links between primary and secondary care interface
- Case management in severe depression
Mental health specialist (Psychiatrist, psychological therapist, CPN, inpatient staff)
- Diagnosis where difficult in primary care
- Specialist medication advice
- Specialist longer term psychological therapy
- Consultation and support to primary care and case manager
INTERFACE ISSUES
Two key themes of enhanced services are to improve primary care mental health services and improve communication at the primary-secondary care interface. To achieve this, professionals working in both primary and secondary care will need to work together and have agreed mechanisms for communication.
Once enhanced services are established, protocols between primary and specialist mental health services can be written which enable patients who have been successfully treated by specialist services to be further treated and/or monitored in primary care. An example might be a patient who makes an almost full recovery following a short inpatient stay and may only require brief intervention or case management by a primary care professional.