Abstract
Background
Despite rising demand for mental health services, a significant proportion (20-30%) of GPs’ referrals to specialist mental health services in Norway are rejected. Little is known about how GPs experience and respond to these rejections.
Aim
This study explores how Norwegian GPs experience the process and consequences of rejected referrals to adult mental health services.
Methods:
We conducted two individual interviews and one focus group with a total of eight GPs. Using Copilot as an AI-tool and Braun and Clarke’s six-phase framework for thematic analysis, we identified key patterns in the data.
Results:
Seven themes emerged: (1) Rejections and frustration, (2) Functioning as gatekeepers, (3) GPs as mental health providers, (4) ADHD and the private sector, (5) Fragmented municipal services, (6) Patient involvement and preparation, and (7) System-level critique and improvement suggestions. GPs described increasing rejection rates, especially for patients with ADHD, anxiety, and depression, highly prevalent conditions in a GP’s practise. Many adapted their referral strategies to meet formal criteria, others chose to refer fewer patient altogether (especially for ADHD). Several provided regular talking therapy themselves, despite limited time. ADHD assessments were described as nearly inaccessible in the public sector, leading to patients contacting private clinics, and their GPs being concerned about equity and quality. GPs also reported limited knowledge of municipal services and limited collaboration with the specialist adult mental health services.
Despite these challenges, GPs emphasized the importance of preparing patients for potential rejection and maintaining therapeutic continuity. They called for improved collaboration with specialist mental health services and more transparent and useful rejection letters.
Conclusion:
These findings highlight the structural tensions in Norway’s challenged mental health services, and the burden placed on GPs as frontline mental health service providers.