Use of general practitioners versus mental health professionals in six European countries: the decisive role of the organization of mental health-care systems

To investigate patterns of use of general practitioners (GPs) and/or mental health professionals (MHPs) for mental health
reasons, across six European countries, and the extent to which these patterns of use are associated with differences in mental
health-care delivering systems.

Data are based on the European Study of the Epidemiology of Mental Disorders (ESEMeD): a cross-sectional survey of a representative
sample of 8,796 non-institutionalized adults from six European countries, conducted between 2001 and 2003 using computer-assisted
interviews with the CIDI-3.0. Countries were classified into: MHP− for countries where access to medical professionals tends
to predominate (Belgium, France, Italy), and MHP+ where access to non-medical MHPs predominates (Germany, Spain, The Netherlands).

Among respondents consulting GPs and/or MHPs in the past year (n = 1,019), respondents from the MHP− group more often consulted GPs (68 vs. 55 % in MHP+ group), GPs and psychiatrists (23
vs. 14 %). People from the MHP+ group more often used MHPs only (45 vs. 32 %), GPs and non-medical MHPs (16 vs. 8 %). GPs
from the MHP+ group were more inclined to refer patients to MHPs. Factors associated with use of GPs versus MHPs were: being
over 49 years, not highly educated, lower income and suffering from mood or severe mental disorders.

Differences in the use of GPs versus MHPs are markedly linked to individual as well as organizational factors. Interventions
are needed, in countries fostering medical access, to reimburse sessions with non-medical MHPs and improve cooperation between
professionals to obtain better practice in access to care.