Psychiatric referral rates and the influence of on-site mental health workers in general practice.

Psychiatric referral rates vary widely between different general practices. To increase our understanding of this variation, we conducted a one-year prospective observational study of outpatient psychiatric referrals made by all general practices (622 referrals from 29 practices) within the catchment area of one inner-city psychiatric service. Contrary to our hypothesis, practices with higher allocations of on-site mental health workers did not have lower psychiatric referral rates. On the other hand, the highest referring practices had lower mental health worker allocations suggesting a possible influence upon referrals in this subgroup. A wide range of quantitative variables explained very little of the referral rate variation, implying that more subjective factors, such as general practitioner attitudes, may be influential in the decision to refer a patient to the psychiatrist.