Sustainable Local Mental Healthcare

The Sustainable Local Mental Healthcare Study (The SLaMH Study) is a collaborative effort understand how mental healthcare pathway’s function and provide evidence of their effectiveness. Despite the commonality of mental health issues, effective treatments remain an evolving field. There is uncertainty surrounding treatment strategies and their impact on patient functionality and labour market participation. In Norway, individuals facing mental health challenges typically consult their general practitioner (GP). Together with the patient, the GP determines the necessary treatment. Does the patient need specialist care, or can symptoms be managed in general practice or primary care? When general practice treatment is chosen, GPs have multiple management strategies available, such as talking therapy, medications, or follow-up consultations. However, we lack a clear understanding of which methods are most effective. Comparing them is challenging, as their success depends on patient and GP characteristics, preferences, and the strategy itself. For patients requiring specialist care, a referral is sent. However, about 1 in 5 referrals are rejected. What happens to these patients? Can they manage without specialist intervention? Are they at higher risk of needing urgent care? What role does the GP play in such scenarios? These questions drive our research, utilising both quantitative and qualitative approaches. Our aim is to improve collaboration between GPs and specialists to ensure appropriate care for patients with mental health issues, optimizing resource utilisation. This project involves patients, GPs, psychologists, psychiatrists, and decision-makers, enhancing the research's quality and practical relevance.

This is a collaborative project between Trondheim municipality, St Olav's Hospital and a the user organization KBT. The project is tailored to meet the current and future mental healthcare needs of the Norwegian population. General practitioners (GPs) are the first point of contact for adults with mental health concerns. GPs also act as a gatekeepers to secondary care, and determine whether patients fulfil the criteria for specialist treatment. At least one in five referrals to specialist mental healthcare are rejected. Management of patients that have been rejected specialist treatment remains at the municipal-level. However, there is no systematic strategy for follow-up of these patients, and little is known about how rejected referrals influence patients and GPs. Given the current capacity problems in general practice, there is a concern if GPs can effectively care for patients with mental health problems. How much time do GPs spend on different treatment strategies, and which approaches are most effective in reducing the negative health and labour market consequences that mental health problems can cause? A major concern is that GPs will refer more patients to reduce their workload, while secondary care providers will become stricter in their selection of patients. The project will provide evidence about management of adults with mental health problems in general practice and at the intersect between municipal- and secondary healthcare. The continuous relevance of the project to knowledge needs is secured through active collaboration between an interdisciplinary research team, mental healthcare providers and stakeholders, and users of mental healthcare services. We will apply analytical designs mimicking randomised experiments using observational data from relevant health and social security registries and databases. Qualitative studies and information from the PraksisNett infrastructure will contextualize and enhance the quantitative findings.