Common mental disorders (CMDs) are prevalent in Malaysia with depression and anxiety disorders being the most frequently diagnosed CMDs in primary care.
There is broad international agreement that CMDs are most appropriately managed in primary care settings. However, there are several challenges facing primary care teams in the management and diagnosis of CMDs in Malaysia, including the training and skillsets of clinicians and the attitudes of primary care healthcare providers to the treatment of CMDs.
RCSI University of Medicine and Health Sciences and University College Dublin Malaysia Campus (RUMC), in collaboration with the Ministry of Health Malaysia, established a Psychiatry in Primary Care (PIPC) service model to address this issue. The model involves a collaborative approach between psychiatry and primary care teams in which a mental health specialist provides support and supervision to help the primary care team in the diagnosis and management of patients with CMDs.
The RCSI study, led by Professor Vincent Russell, Associate Professor in the Department of Psychiatry at RCSI, set out to explore the primary care teams' experience of this service and to identify barriers and facilitators in delivering care for patients with common mental disorders. It was published in BMJ Open.
In the study, RUMC psychiatrists, accompanied by medical students, provided one half-day consultation visit per week in two clinics, over an eight-month period. The consultation involved a psychiatric assessment of patients with suspected CMDs and a face-to-face discussion with the referring doctor before and after seeing the patient. The assessment also included involvement of family where possible and with the patient's consent.
In evaluating the perceived impact of the PIPC initiative, 17 primary care medical, nursing and allied health staff in two government-operated primary care clinics were interviewed by a researcher who had no involvement in the clinical service, before and after the PIPC initiative was introduced. The study found the primary care doctors to be receptive to the intervention.
In the interviews prior to the commencement of the PIPC service, clinicians tended to equate CMDs with stress and approached care holistically. The clinicians in the first interviews reported considerable independence in mental healthcare and positively appraised current practices.
Following the implementation of the PIPC model, the primary care teams reported a greater understanding of CMDs as treatable conditions and increased awareness of current service issues in the delivery of mental healthcare.
Barriers in the delivery of care for CMDs included time pressures and the competing demands from other areas of clinical service delivery.
The study provides insight on challenges and opportunities for implementing evidenced-based models of care for CMDs in primary care settings in Malaysia and paves the way for the potential upscaling of primary care services for common mental disorders in low-income and middle-income countries.
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