Primary mental health workers addressing youth mental health problems and referrals in general practice: a seven-year time-trend study

BackgroundPrimary mental health workers (PMHWs) support general practitioners in the care for youths who presumably have mental health problems. They provide consultation, screening and triage, short term treatment and transitional care. This study aims to investigate mental health problems presented to and referrals made by PMHWs over a seven-year period (2017-2023).MethodsPMHWs recorded characteristics, mental health problems and referrals for 7393 youths between January 2017 and December 2023. Time trends were analyzed using mixed logistic regression analyses, with year and youths' sex as fixed effects. Analyses were performed for children (0-12 years) and adolescents (13-23 years) separately.ResultsFrom 2018, emotional problems were the main reason for consulting PMHWs in both age groups. Percentages of these problems as assessed by PMHWs increased significantly in recent years. On average, 64.4% of children and 62.0% of adolescents were referred after consulting a PMHW. Children's referrals to secondary mental health care decreased significantly in 2020, but increased in subsequent years. Adolescents' referrals to secondary mental health care showed no significant time trends. Rates of youths without referral were lowest in 2020. In 2023, percentages of children and adolescents being referred to primary mental health care exceeded referral rates to secondary mental health care.ConclusionsThe significant increase in emotional problems as assessed by PMHWs is reason for concern. Referrals by PMHWs gradually developed to less intensive and less costly types of care. Since over one third of youths were helped by PMHWs without referral, implementing PMHWs in general practice may be a valuable way to support general practitioners in providing care for youths with mental health problems.