Of these 13 percent had an anxiety disorder 7 percent

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had a diagnosable mental health problem (MaGPIe Research Group 2003). Of these: 13 percent had an anxiety disorder 7 percent had a depressive disorder 3 percent a substance use disorder. In about half these patients, the disorder was current within the past month. The GPs themselves estimated that about half of their patients had experienced psychological
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18 Primary Health Organisations: Service development toolkit for mental health services in primary health care problems, and that the mental health problems were moderate to severe in about 10 percent of those. Although a body of prior research has suggested that GPs ‘miss’ half the psychological problems present in their patients, the MaGPIe study found that, in New Zealand, this was only a problem among patients who had little recent contact with their GP. Interventions to improve patient outcomes These results suggest that interventions to improve patient outcomes by addressing GP recognition of mental disorder may be more effective if they: foster continuity of care focus on the disorders most likely to be missed take high levels of co-morbidity of common mental disorders into account encourage patient disclosure of psychological issues target new or infrequent attendees (MaGPIe Research Group (in press)). Although 20–25 percent of the general population will experience a mental disorder at any point in time, only one in three of those with a disorder will get any treatment. What is more, only one in four of those treated will reach specialist mental health services, while the rest will be treated by the primary health care team (Hornblow et al 1990). Providing effective treatment There are concerns that, if a problem is identified at the primary health care level, the most effective treatment is only being provided to a small number of people. A cross- sectional survey in the US found that less than 15 percent of people with a diagnosable mental disorder were receiving care that could be considered consistent with evidence- based treatment. Even for those with the most severe and impairing mental illness, only 25 percent received guideline-concordant treatment. Racial minorities and the poor were particularly at risk for not receiving evidence-based care. The rates of primary health care utilisation vary. For example, 80 percent of people who have an anxiety or depressive disorder consult their primary health care practitioner. However, the rate is lower for those with alcohol-related disorders. Mental health issues are frequently not the focus of the consultation, because of barriers to disclosure (Wells et al 1994). Predictors of future mental health issues Violence and abuse rates are high in our society. They are not limited to one gender, religious, cultural or income group – and they are associated with poor mental health. A summary of the available research indicates that childhood sexual abuse and being the victim of violence increases the risk of later mental illness and mental health problems. Early unstable and unsatisfactory childhood and adolescent family life experiences also predict poorer mental health later in life.
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  • Fall '19
  • primary health care, Primary Health Organisations

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