A qualitative study of referral to community mental health teams in the UK: exploring the rhetoric and the reality

<p>Abstract</p> <p>Background</p> <p>Generic community mental health teams (CMHTs) currently deliver specialist mental health care in England. Policy dictates that CMHTs focus on those patients with greatest need but it has proved difficult to establish consistent referral criteria. The aim of this study was to explore the referral process from the perspectives of both the referrers and the CMHTs.</p> <p>Methods</p> <p>Qualitative study nested in a randomised controlled trial. Interviews with general practitioner (GP) referrers, CMHT Consultant Psychiatrists and team leaders. Taping of referral allocation meetings.</p> <p>Results</p> <p>There was a superficial agreement between the referrers and the referred to on the function of the CMHT, but how this was operationalised in practice resulted in a lack of clarity over the referral process, with tensions apparent between the views of the referrers (GPs) and the CMHT team leaders, and between team members. The process of decision-making within the team was inconsistent with little discussion of, or reflection on, the needs of the referred patient.</p> <p>Conclusion</p> <p>CMHTs describe struggling to deal with GPs who are perceived as having variable expertise in managing patients with mental health problems. CMHT rhetoric about defined referral criteria is interpreted flexibly with CMHT managers and Psychiatrists concentrating on their own capacity, roles and responsibilities with limited consideration of the primary care perspective or the needs of the referred patient.</p> <p>Trial Registration number</p> <p>ISRCTN86197914</p

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Background stimulus for invariantspectral sensitivity

Increment‐threshold spectral sensitivity was determined with backgrounds of four different chromaticities and two different troland (td) levels. One background was equivalent to a field delivering to the receptors an equal quantal flux at all visible wavelengths. Another background approximated CIE Illuminant A. Light from a chromatically unfiltered xenon‐arc lamp provided a third background. The fourth background was monochromatic at 470 nm. Backgrounds were presented at 10 and 1000 td. Foveal spectral sensitivity determined on each of these backgrounds was compared to that measured for the dark‐adapted state. The 10‐ and 1000‐td equal‐quantal fields yielded the functions that most closely approximated the curve resulting from the dark‐adapted condition, suggesting that such an equal‐quantal field, which appeared as a saturated blue, is neutral for measurements of spectral sensitivity. Because of the putative contribution of the opponent chromatic channels to spectral sensitivity determined using increment thresholds, the results further suggest that at the detection stage of these channels an equal‐quantal field provides a balanced state of adaptation

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