‘We need to better distinguish between patients with mental problems’

Too many people with mental disorders receive psychiatric treatment, although being in care organized by their family doctor would be much better. A distinction must be made between patients with severe mental problems that require proper treatment and patients suffering from similar symptoms. Professor Peter Verhaak argued this in his inaugural lecture (February 15, 2011) as Professor of General Practice Medicine at the University Medical Center Groningen/University of Groningen. ‘Not everyone who is feeling down is suffering from severe depression’, according to Verhaak.

A number of effective treatments for depression have been developed in recent years. However, this has not led to a drop in numbers of cases of depression. Some of the explanations for this so-called depression paradox are that not everyone with depression seeks or wants help, that those treated by their GP experience less benefit than expected or that patients are not following the prescribed treatment. The solution to the depression paradox suggested by many is even more intensive treatment, more protocols and more specialist care.

Alternative approach to the depression paradox

Professor Peter Verhaak would prefer another approach. He wonders whether the problems encountered in general practice are really comparable to the psychiatric disorders for which specialist mental healthcare provides evidence-based treatment. Is the clinical evidence that has been found applicable to general practice? Do family doctors actually treat the same disorders as psychiatrists? Or are they often treating people with problems in life who are simply in need of some guidance?

Distinction

Verhaak makes the case for distinguishing between patients with severe mental problems and patients who ‘only’ have similar symptoms. The first group needs to receive proper treatment while the second group would benefit from a general practice approach that does not ‘psychiatricize’ their problems. Diagnosing patients as depressed could lead to their behaving in line with the diagnosis and their environment doing so as well. The diagnosis then begins to lead a life of its own. The patient is in the hands of an independent threat from outside and has to sit and wait whether medication or some other type of treatment will take effect. When this is not the case, feelings of impotence will only increase. And if treatment does work the question then arises when the patient will be able to go without again.

‘Basic Mental Healthcare Centre’

The family doctor’s role as a trusted healthcare practitioner remains crucial. They will need support from general-practice support staff and primary-care psychologists, social workers and social psychiatric nurses. ‘Perhaps we’ll call this a “Basis-GGZ” (Basic Mental Healthcare Centre) in the future’, Verhaak says. ‘A very interesting research question would then be to determine how severe the mental problems are that the short-term treatment provided by such a “Basis-GGZ” would be able to cope with, and where more specialist care is indicated.’

Curriculum Vitae

Dr. P.F.M. (Peter) Verhaak (Utrecht, 1952) became professor by special appointment in general practice medicine in 2010, with a particular focus on the general-practice mental healthcare provided by the University Medical Center Groningen/University of Groningen. The endowed chair is funded by the NIVEL Foundation (Stichting NIVEL). Peter Verhaak studied psychology at Utrecht University. He was awarded a PhD in Medical Sciences in 1986 with a thesis entitled ‘Interpretatie en behandeling van psychosociale klachten in de huisartspraktijk’ (Interpretation and treatment of psychosocial complaints in general practice). In the years to come, Verhaak’s research will focus on developing several short-term treatments for mental disorders and on how to distinguish between patients who can be treated for mental disorders in general practice and those who require specialist psychiatric treatment.