SLaMH- Sustainable Local Mental Healthcare

Project worker from KBT: Juni Raak Høuseth
Project period: November 2023-November 2027
Project leader for the work package KBT participates in: Silje L. Kaspersen (ISM, NTNU/SINTEF)

What happens to those who fall between the cracks?

KBT contributes to Work Package 4 in the SLaMH study, a project looking at the mental health needs in the Norwegian population of today and the future. WP4 is focusing on the experiences of users and employees with rejected referrals to specialist healthcare. Through a qualitative approach, they will examine the experiences of patients, GPs, and employees in both municipal and specialist health services.

This is the SLaMH study

SLaMH stands for Sustainable Local Mental Healthcare. The project has four work packages, with KBT involved in Work Package 4. This is a collaboration between Regforsk/NTNU, Trondheim Municipality, St. Olav’s Hospital, and KBT.

1. Systematic stakeholder collaboration (co-led by Trondheim Municipality and St. Olav’s Hospital):
   1.1 Continuously ensure the relevance of the research questions.
   1.2 Effective dissemination of research findings to users and stakeholders.
   1.3 Construct guidelines for GPs on how to deal with rejections.
2. Management of patients with mental healthcare problems in general practice (led by Christina Edwards):
   2.1 Describe patient care in general practice.
   2.2 Examine the effect of management strategies on healthcare use and labour market participation.
   2.3 Study how GP- and municipal characteristics influence use of different management strategies.
3. Interaction between municipal and specialist mental healthcare utilization (led by Christina Edwards):
   3.1 Examine patterns of interaction between GPs and specialist mental healthcare.
   3.2 Analyse effect of GPs referral threshold on healthcare use and labour market participation.
   3.3 Study healthcare use and labour market participation among patients with rejected referals.
4. User- and provider experiences with rejected referrals to secondary care (led by Silje L. Kaspersen):
   4.1 Investigate patients’ experiences with rejected specialist mental healthcare referrals.
   4.2 Investigate GPs’ experiences with rejected referrals, and patient management after rejection.
   4.3 Investigate service providers’ perception of the consequences of rejected specialist mental healthcare referrals for municipal- and specialist mental healthcare.

What are the experiences of patients and healthcare providers?

Work Package 4 involves recruiting patients whose referrals have been rejected within the last 6-12 months. The study will explore how rejections are communicated to patients, how they experience these rejections, and what they expect from their GPs and other services after a rejection.

Regarding GPs, we will investigate how GPs experience the high number of rejected referrals and how they cope and make decisions on whether to rerefer rejected patients, treat patients themselves, refer patients to other municipal psychosocial services, or recommend non-governmental community care or private services

In the final subtask, the projectwill gather knowledge about the degree to which municipal mental health
services substitute specialist services in the case of rejected referrals, and service providers’ perceptions of
the consequences that rejected specialist referrals have on use of municipal- and secondary mental
healthcare.