The challenges of collaboration between general practitioners and psychiatrists The case of chronic depression in French-speaking Switzerland

The collaboration between general practitioners (GPs) and psychiatrists in the management of chronic depression is considered as necessary but found suboptimal in the literature. The present qualitative study aims to better understand the factors influencing the decision to refer a patient with chronic depression to a psychiatrist. In order to do so, we conducted three focus groups with GPs in the French speaking part of switzerland. The focus groups were recorded and transcribed, then coded by three members of the pluridisciplinary research team, using the software MaxQDa. We show that GPs carryout an implicit classification process of the patients, parting those who are "good cases" for the psychiatrist from those who express their suffering only by the body. The latter will only be treated at the GP's practice. We argue that such a classification may therefore produce unequal access to psychotherapy. We identify several reasons for GPs to refer patients with chronic depression. These reasons rarely relate to the acknowledgement of a specific expertise of the psychiatrist in the management of chronic depression. It also appears that GPs perceive themselves as "specialists of the relationship", which they consider central to themanagement of chronic depression. In addition, some GPs have negative representations of psychiatrists. These factors suggest the existence of issues around professional boundaries, which can work against collaboration. In conclusion, a clarification of the specificities of the GPs and the psychiatrists - through training and interprofessional meetings - would help reduce the negative representations of GPs about psychiatrists and promote collaboration, thus facilitating the referral of patients with chronic depression to the psychiatrist.