ABSTRACT: Background: Many individuals with mental health disorders remain untreated although
effective treatment exists. This is known as the mental health gap. The gap is particularly
wide in low and middle income countries, such as Brazil. One of the strategies suggested by
the World Health Organization to reduce the gap, is to integrate mental health into primary
care. A group of family physicians and psychiatrist created a collaborative care model, in
Brasilia, Federal District, Brazil. A series of workshops were delivered to primary care
doctors, covering depression, anxiety, psychosis and substance misuse.
Objective: To measure mental health referrals from primary to secondary care the year before
the beginning of these workshops, and the year after, including the months in which the
workshops took place.
Method: An observational longitudinal study was conducted, with monthly measures of
referrals from primary care to secondary care psychiatry, between October 2017 and October
2019. Twenty physicians who enrolled in the workshops were included in the analysis. The
control group consists of 20 physicians working in the same health district who did not attend
the workshops. All tests were performed with 95% confidence. The tests applied to samples
were: Shapiro-Wilk Normality Test, Wilcoxon Test for two samples and Kruskall Wallis test
for comparison of several samples.
Results: For those who attended the workshops at least twice, there was a statistically
significant decline in referrals, with a P value of 0.04. There is a general trend toward increase
in referrals for those who did not attend the workshops, although with no statistical
significance, probably due to sample size.
Conclusion: The workshops seem to be an interesting strategy to increase access to mental
health in primary care, and reduce referrals to secondary care
