Defining when specialised mental health care is needed: a focus group study

Patient is unable to function in daily life or unable to care for children.

Substance abuse, trauma, psychosis, anxiety, depression, self-harm, suicidality, reckless or extreme behaviour, and eating disorders.

Worsening of the patient’s mental illness.

Patient’s motivation and cognitive capacity for treatment.

Needs a specialist’s help for evaluation of medicine and diagnosis.

Treatment options only in specialised health care.

Patient is unable to care for children or attend work. Patient lacks or has an unsustainable network.

Patient has deteriorating relationships.

The patient’s symptoms (risk for suicide, psychosis).

The patient’s daily functioning level.

Patient has a fragile or lacking network.

Geographical factors and infrastructure.

Patient has a fragile or lacking network.

Patient has a tired family.

Limitations of the GP’s competence and confidence.

Patient lacks housing.

Patient’s upbringing.

Patient’s network or family.

If request is made during night or weekend.

Patient living far away from SMHC, availability of transport.

The GP cannot defuse the situation.

GPs are not regarded as a part of mental health care. There is a lack of time at the GP’s office.

The GP has to adapt the definition of need to fit the specialist’s definition.

Professional medical discretion concerning the patient’s upbringing, personal history.

Patient’s earlier experiences of treatment in SMHC.

Patient’s actual or expected effect of treatment from SMHC.

Availability of treatment in primary mental health care or private clinics.

Estimated time on waiting list for the patient.

Cost–benefit assessment.

Patient history of treatment and effect of treatment in SMHC.

Risk of the patient having no effect from treatment in SMHC.