Challenges in Primary Mental Health Diagnosis

Background Of The Study

Current clinical reforms continually aim to improve primary health care. Mental illnesses and disorders are universally considered leading causes of morbidity. These illnesses are primarily handled by general practitioners; from their diagnoses to their processes of recovery. In most occasions, this primary duty and ability by these general practitioners with the aim of detecting, diagnosing and treating patients with mental illness is considered unsatisfactory. General practitioners are involved in the provision of primary care, and not specialized care. In comparison to specialized care, primary care is more attainable to the public. This kind of care is also more comprehensive and extensive as it is inclusive of both physical illnesses and mental illnesses (Fleury, 2012). To a large extent also, this kind of treatment is less stigmatizing to persons with different characteristic ailments.

One of the leading causes of morbidity in industrialized countries around the world is mental illnesses. Fleury et al (2012) point out this morbidity rate to range from 4 to 26.4% on an annual basis. Furthermore, patients with mental illnesses are widely discriminated and stigmatized against in most environments, including the health care settings (Ando et al, 2013; Thornicroft et al, 2009). Extensive and wide research has been conducted on the aspect of social and self- generated stigmatization that affects these kinds of persons in hospital settings. This self- perceived stigma is greatly associated with societal stigma (Girma et al, 2013). Mental illnesses in primary care settings and among the general practitioners are therefore a critical concept in regards to health care.

Study Rationale

General practitioners are the immediate and most primary source of care to these patients with mental illnesses. As a significant problem in clinical settings, mental illnesses cause about 80% of all consultations within a given year in industrialized societies. These usually involve general practitioners (Rabin et al, 2009). Arnd 40% of these consultations are usually diagnosed with significant psychological symptoms. Some of the substantial burdens associated with mental illnesses include their cost of treatment, loss of productivity, impairment as to the functionality and the obvious reduction in the quality of life. From these basic aspects, GPs are increasingly called forth to provide for care and treatment to these patients. Specialized forms of treatment of mental illnesses such as psychiatric services can neither meet the cost or the demand for the treatment. As a result, GPs are also often involved in connecting the two sides. The GP’s role becomes crucial as they would then act to connecting the specialized service providers with the service users; who are those with psycho- social issues that require those kinds of special services (Mykletun et al, 2010). The role provided by the GPs in this case is essential as it also considers cases of substance abuse and physical complications.

Regardless, in most instances, GPs’ roles in the treatment and management of mental illnesses are considered unsatisfactory. Some researches show that this treatment, even at the level of detection, is poor. Longitudinal studies, moreover, reveal that around 14% of patients with certain mental illnesses go undiagnosed for as long as three years (Walters et al, 2008).

Aims And Objectives Of The Study

The main aim of the study is to examine the means by which general practitioners deal with cases of mental illnesses, the impact of these efforts and the factors involved in the management strategies. Management in this case would include the processes of detection, diagnosis, treatment and recovery of these patients with mental illnesses in primary care settings.

In achieving this main objective, the study would adopt the following specific objectives:

To explore and find the key principles and concepts behind mental illnesses in primary health care, their basic systems and methods of treatment involved in the management of such diseases.

To identify and analyze the challenges that arise in the management of mental illnesses among general practitioners

To systematically analyze the perceptions of mental illnesses among general practitioners

To analyze the concept of stigma in relation to mental illness, foundationally relating to general practitioners

Methodology

This study would employ systematic literature review as the main method of research. According to Dewy and Drahota (2016), this method involves the careful identification, selection and critical appraisal of research in a bid to answer and meet the study objectives. In accordance with this method, research would involve identifying various articles relevant to the topic of mental illness and general practitioners. The study would extensively and comprehensively analyze the concept of management as explored under various articles.

A conductive and transparent search would at first be conducted in accordance with a well-organized search strategy with specific focus on mental illness among general practitioners. This section would also include the development of search terms, timeframe limitations for relevance, platforms searched and the database names and limits (Gough et al, 2012). This aspect would include the use of the PICO framework which would be necessary in the breaking down of the research objectives so as to come up with keywords and the search terms. The search terms in this case would include: mental illness, mental disorders, psychological disorders, conditions, general practitioners and primary health care.

Study design

Systematic design would be the primary design of the study. From this design, this study would be able to critically asses and evaluate relevant research studies. After locating, collecting and combining information from various sources, the study would evaluate bodies of literature on the aspect of mental illness among general practitioners. This method would include the description of the findings and may also involve data pooling, which involves Meta-analysis.

Study population

The eligible population in the study would be the General Practitioners working in the Primary Care Centers and patients with mental illnesses.

Data collection and analysis

Data would be extracted from various articles and the inclusion and exclusion criteria would be applied to establish relevance. Literature on the topic would be retrieved from specific sources such as peer reviewed and published articles, journals and guidelines. Data collection and analysis would significantly involve qualitative and quantitative research. Data collection would involve the assessment of the included studies using critical appraisal tools such as the CASP framework. The CASP framework is an easily adoptable appraisal tool that ensures all the eligible studies reviewed would be credible, valid and applicable (Millward, 2013).

Data synthesis and analysis would be qualitative in nature. Qualitative research explores the in depth understanding of the concept of mental illnesses in primary care settings among general practitioners. This study would focus on the interpretation and description of the findings, summarizing the findings and evaluating the characteristics and contentions of the studies.

REFERENCE LIST

Ando, S., Yamaguchi, S., Aoki, Y., Thornicroft, G (2013) Review of mental health related stigma in Japan. Psychiatry Clin Neurosci

Gough, D., Oliver, S., Thomas, S (2012) An introduction to systematic reviews. Systematic Reviews. London

Dewy, A., Drahota, A (2016) Introduction to systematic reviews: online learning module. Cochrane Training

Girma, E., Tesfaye, M., Froeschl, G., Moller, A., Dehning, S., Muller, N (2013) Facility based cross- sectional study of self-stigma among people with mental illness: towards patient empowerment approach. Int J Ment Health System.

Millward, H (2013) CASP Tools for Qualitative Research Studies (Accessed on 30th December, 2019)

Mykletun, A., Knudsen, K., Tangen, T., Overland, S (2010) General practitioner’s opinions on how to improve treatment of mental disorders in primary health care. Interviews with one hundred Norwegian general practitioners. BMC Health Serv Res

Thornicroft, G., Brohan, E., Rose, D., Sartorius, N., Leese, M (2009) Global pattern of experienced and anticipated discrimination agains people with schizophrenia: a cross- sectional survey. Lancet

Rabin, S., Maoz, B., Shorer, Y., Matalon, A (2009) Balint groups as shared care in the area of mental health in primary medicine. Ment health Fam Med

Walters, P., Tylee, A., Goldberg, D., Murray, R., Kendler, S., McGuffin, P., Wessely, S., Castle, J (2008) Psychiatry in Primary Care. Essential Psychiatry