Counsellors in general practice

Relationship between practice counselling and referral to outpatient psychiatry and clinical psychology

BACKGROUND

Although reduction in the use of secondary care mental health services is a suggested benefit of counselling in general practice, there has been little empirical investigation of this relationship.

AIM

To investigate the relationship between the provision of counselling in general practice and the use of outpatient psychiatry and clinical psychology services across a geographical area.

METHOD

Information on referrals to outpatient psychiatry and clinical psychology from all general practices in the London Borough of Islington over one year (October 1993 to September 1994) was collected from the routine information systems of the main hospital departments serving this area. Referral rates per 1000 practice population were compared for practices with and without a practice-based counsellor.

RESULTS

Fifteen (35%) of the 43 practices had a counsellor based in the practice. The median referral rate to clinical psychology was higher in practices with a counsellor (4.1 per 1000) than in practices without a counsellor (0.8 per 1000). There was no relationship between the provision of practice counselling and median referral rates to outpatient psychiatry (1.8 per 1000 with a counsellor, 1.7 per 1000 without a counsellor).

CONCLUSION

Provision of practice counselling in the study was associated with higher referral rates to clinical psychology and no difference in referral rates to outpatient psychiatry. This is in contrast to the hypothesis that counselling reduces the use of secondary care mental health services.

Counsellors in primary care in Southampton: a questionnaire survey of their qualifications, working arrangements, and casemix

BACKGROUND

There has been an upsurge of interest in counselling in primary care over the past five years. This has been stimulated by a growing demand for non-drug treatment of emotional disorders and by the extension of reimbursement for the costs of counsellors. Continued calls for careful evaluation have been largely unheeded in the face of heady growth.

AIM

To establish the prevalence of counselling services in the 67 general practices in the Southampton and South West Hampshire Health District, and to describe in detail their qualifications, working arrangements, and casemix.

METHOD

A questionnaire enquiring about counselling services was sent to all the general practices in the district. A second questionnaire was then posted to all the counsellors identified as working in these practices.

RESULTS

Twenty-six (39%) practices employed one or more counsellors. Fundholding practices were four times more likely than non-fundholders to employ a counsellor. Most of the counselling work was short term (4-20 sessions). The most common presenting complaints were relationship problems, depression, anxiety, and bereavement.

CONCLUSION

This descriptive study highlights the wide variation in the qualifications and training of counsellors. Until the issue of effectiveness is resolved through further research, the best safeguard of quality is to ensure that counsellors meet the appropriate training standards laid down by the British Association of Counsellors. Monitoring standards is a legitimate task for those commissioning health care who are increasingly responsible for reimbursement of a counsellor's salary. Counsellors who meet appropriate training criteria should be encouraged to pursue accreditation with the British Association of Counsellors. Those who do not meet these criteria should be encouraged to undergo additional training.

Relationship between the provision of counselling and the prescribing of antidepressants, hypnotics and anxiolytics in general practice

BACKGROUND

The provision of counselling in general practice is increasing, despite uncertainty concerning its effectiveness. Furthermore, the relationship between counselling and prescribing of antidepressants, hypnotics and anxiolytics in general practice is not known.

AIM

This study set out to assess the relationship between provision of counselling and prescribing of antidepressants, hypnotics and anxiolytics in general practice.

METHOD

An observational, cross-sectional study of general practices in Oxfordshire Family Health Services Authority was undertaken. Practices were surveyed on the availability of counselling services. The quantity and cost of prescribing of psychotropic drugs over one year (April 1992 to March 1993) were compared for practices with different levels of counselling provision.

RESULTS

Of the 82 (96%) respondents, 74 (90%) referred patients for counselling; of these 74 practices, the highest levels of prescribing, in terms of number of items and net ingredient cost, were seen in those practices that employed a counsellor working on the premises. The lowest levels of prescribing were seen in those practices that referred their patients to a counsellor not working on the practice premises.

CONCLUSION

The relationship between the provision of counselling and the level of prescribing of antidepressants, hypnotics and anxiolytics is complex. In this study lower levels of prescribing of these drugs in practices with higher provision of counselling were not observed.

Counsellors in English and Welsh general practices: their nature and distribution

OBJECTIVE

To establish the prevalence of counselling services in English and Welsh general practices and factors associated with their distribution; to describe qualifications, working arrangements, and case mix of "counsellors."

DESIGN

Postal questionnaire and telephone interview survey of a sample of about one in 20 general practitioners in England and Wales.

SETTING

English and Welsh general practices.

SUBJECTS

1880 general practitioners of whom 1542 (82%) completed questionnaires.

MAIN OUTCOME MEASURES

Prevalence and distribution of practice counselling services; counsellors' qualifications and funding; types of patients referred.

RESULTS

586 counsellors were distributed among 484 of the 1542 practices. Three types of counsellor predominated: community psychiatric nurses (187); "practice counsellors" (145); and clinical psychologists (95). Practice characteristics which independently predicted the presence of a counsellor were for community psychiatric nurses four or more partners (odds = 1.72, 95% confidence interval 1.18 to 2.26); for practice counsellors stress clinic (odds = 2.22; 1.83 to 2.61), training practice (odds = 1.70; 1.24 to 2.16), and health region (chi 2 = 55.94; df = 14; p < 0.001); and for clinical psychologists list size of > or = 10,500 (odds = 1.79; 1.09 to 2.49), training practice (odds = 1.78; 1.31 to 2.25), health region (chi 2 = 48.31; df = 14; p < 0.001). 197 counsellors had training in counselling. The qualifications of 85 were unknown to the general practitioner. The principal source of funding was the district health authority for community psychiatric nurses (150) and clinical psychologists (58) and the family health services authority for practice counsellors (76). All counsellors were referred a wide range of problems.

CONCLUSIONS

Counselling services are wide-spread in general practice, but a high proportion of counsellors lack qualifications, and many may be referred problems outside their knowledge.