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Table 2 Selected key quotes representing the themes and subthemes relating to GPs views on mental health service provision

From: Suicide prevention in primary care: General practitioners' views on service availability

Theme Subtheme Statement/meaning unit
Barriers Lack of access to Secondary MH services "Main problem is lack of staff, psychologists, CPNs and now have half the number of psychiatrists in their area than there should be."
   "Cannot refer directly, need to go via CMHT who may send referral back."
  Long waiting lists "Have a two-tier service for brief intervention such as CBT but waiting times are about 18 months."
   "Long waiting lists for counsellors so GPs do not bother referring."
   "Waiting lists for mild to moderate mental health problems need to be improved as currently very poor."
  Closed lists "Psychology service was closed for 2 years, no access to psychology in this area."
   "Lack of counsellors and psychologists, 2 year waiting lists and no CBT available."
  Not admitted to inpatient unit "Waiting times and a lack of beds is a problem. Sometimes patients who are referred for assessment cannot be admitted as there are no beds. Sometimes patients have to wait too long."
  Lack of dual diagnosis services "Main problem in this area is for alcohol issues as these patients are a high risk for suicide yet they are hard to admit if they need to detoxify."
Referrals Access & Rigid criteria "GPs do not have quick access to support services within mental health services, especially at early stages where they have no immediate access. This may be due to the CMHT not allowing immediate access as they have very rigid criteria. Therefore need faster assessments for vulnerable patients, especially if the GP has assessed them and thinks they are in need of some treatment."
  Do Not Attend/reply - no follow up "All referrals go to CMHT who then decide who to access and invite for assessment. If no response from patient the CMHT do not follow up. The referral system is not good."
  Referred back to Primary Care "Service not good if service feels patients do not need to be seen. CMHT seem to refer patients back, find every reason not to see them - this may be due them being under resourced."
  Under resourced "No immediate access at initial stages and staff should have more specific training. Provision of CMHT service is based on resources not on patient needs."
  Positive systems in place "Triage system for prompt assessment of mental health issues. If the GP feels there is a problem, can get it assessed quickly by a mental health worker who will refer the patient for specific treatment."
Managing Change GPs feel unsupported "Feel very unsupported as GPs. Currently trying to improve services for people with anxiety/depression as if not seen as a major illness referrals will not be seen by anyone."
  Lack of staff & high turnover of staff "Main problem is lack of staff, psychologists, CPNs and now have half the number of psychiatrists in their area than there should be."
  Community Psychiatric Nurse (CPN) on site "Was better when CPNs were part of the surgery and not separate as now the SMI criteria is not met by some moderate/low depression cases and they are rejected and do not get seen or reviewed."
   "Very good access to CPN service. If psychotic or urgent case can contact psychiatrist directly. CMHT is on site so can ring duty CPN everyday and they'll sort out referral."
  Crisis Team "Used to have CPN and psychiatrist attached to the surgery with meetings every month which reduced waiting time to two weeks. Now have to go via CMHT which is not as good, would prefer old system but cannot afford or have access to resources."
   "Better services as some people are not seen by crisis team even if GP has recommended they need to be. Sometimes GP has to really force for patients to be seen. Feels there should be assessments in patients' own environment not only in A&E."