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Goldberg and Huxley's model revisited

Published online by Cambridge University Press:  02 January 2018

Treasa O'Sullivan ,
Amanda Cotton  and
Allan Scott
Treasa O'Sullivan
Affiliation:
Royal Edinburgh Hospital
Amanda Cotton
Affiliation:
Royal Edinburgh Hospital
Allan Scott
Affiliation:
Andrew Duncan Clinic, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh EH10 5HF
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Abstract

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Information
Psychiatric Bulletin , Volume 29 , Issue 3 , March 2005 , pp. 116
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Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Copyright © 2005. The Royal College of Psychiatrists.

We were interested that a recent editorial in The Lancet used a model of referral to specialist psychiatric services from 1980 (Reference Peen and DakkerPeen & Dakker, 2004). The original model (Reference Goldberg and HuxleyGoldberg & Huxley, 1980) has been refined (Reference GoldbergGoldberg, 1995). One important prediction it makes is the number of adults who will be in contact with the totality of specialist mental health services. We decided to test the relevance of this model for north-east Edinburgh in 2003.

We received 1390 new referrals from the population aged 18-64 years inclusive. (Our records were hand-searched to ensure each individual was counted only once.) This is equivalent to 2.3% of the catchment population in 1 year, or 230 people per 10 000 population (95% confidence interval 220-240). The model predicts a figure of 208 adults in contact with the totality of specialist mental health services.

We conclude that the model substantially underestimated the utilisation of specialist psychiatric services. It would take a great deal more work to calculate the variance; we would have to add to the patients newly referred, patients already known to our own service, services for the elderly, NHS psychotherapy, and clinics for people with alcohol, drug and eating problems.

We do not know to what extent our findings can be generalised. We only hope that those who purchase general adult psychiatric services are not doing so on the basis of this model.

References

Goldberg, D. (1995) Epidemiology of mental disorders in primary care settings. Epidemiologic Reviews, 17, 182–190.Google Scholar
Goldberg, D. & Huxley, P. (1980) Mental Illness in the Community: The Pathway to Psychiatric Care. London: Tavistock Publications.Google Scholar
Peen, J. & Dakker, J. (2004) Is urbanicity an environmental risk-factor for psychiatric disorders? The Lancet, 363, 2012–2013.Google Scholar
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