Cochrane Summaries

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On-site mental health workers delivering psychological therapy and psychosocial interventions to patients in primary care: effects on the professional practice of primary care providers

Harkness EF, Bower PJ
Published Online: 
7 July 2010

Most people with mental health problems are treated by their family physician or general practitioner. Physicians will treat these problems, often without referral to mental health specialists, and at times the care is not consistent and could be improved.

This review investigated whether having mental health workers on-site to work with physicians at their offices would change the care that physicians provide. Forty-two studies were reviewed in which on-site mental health workers, such as counsellors or psychiatrists, worked alongside physicians to provide therapy to patients. The review found that when there were mental health workers on-site, patients may reduce the number of visits to their doctors; doctors may reduce how often they refer patients to off-site mental health specialists; doctors may reduce the number of drugs they prescribe to the patients who see the mental health workers; and the costs related to those drugs may be lower. However, these reductions were small and not found consistently in all the studies.

The review also found that there may be little or no difference in how the doctors prescribe drugs or refer patients who have mental health problems but are not seeing the on-site mental health workers. It is also not known what the effect of on-site mental health workers had on how well physicians recognised and diagnosed mental health problems.