Over 25 years ago Goldberg & Huxley (Reference Goldberg and Huxley1980) proposed a widely recognised pathway to psychiatric care. This model, which has since been refined (Reference GoldbergGoldberg, 1995), predicts that 20.8 adults per 1000 population per year will be in contact with specialist mental health services. We have previously demonstrated that this model underestimated the utilisation of specialist psychiatric services in North East Edinburgh in 2003 (Reference O'Sullivan, Cotton and ScottO’Sullivan et al, 2005). We decided to resurvey referrals in the same area for 2005 to attempt to replicate our findings.
We recorded all new referrals from general practitioners (GPs) to mental health services among those aged 18–64 years in our sector. This included general and specialist psychiatric services, namely clinical psychology, psychotherapy, addictions and eating disorder services. Given the emphasis on social factors in the original model, we checked for a correlation between the levels of deprivation as measured locally by the Scottish Index of Multiple Deprivation (SIMD; http://www.scotland.gov.uk/Topics/Statistics/SIMD/Overview) and referral rates from individual GP practices.
There were 1541 new individual referrals of those aged 18–64 years, which is equivalent to 24.6 per 1000 catchment population per year (95% CI 24–26). New referrals alone exceeded the number predicted in the model. Spearman's rank correlation coefficient between the SIMD score of individual practices and referral rate was 0.44.
In an atmosphere of continual change in the National Health Service, we urge service planners to be mindful of the gross underestimation of current referral to psychiatric services by Goldberg and Huxley's model.
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