Understanding Patient Referral Practices and Perceptions of Mental Health Professionals Among Neurologists.

Background and objectives: To examine neurologists' practices in managing mental health care. The study aims to identify gaps in coordination between neurology and mental health care and to assess neurologists' perspectives on integrating mental health services into neurology clinics.

Methods: A mixed-methods approach was used, combining survey data and qualitative interviews of key informants. The survey assessed management strategies for psychiatric comorbidities through 3 hypothetical cases and questions regarding referral patterns, accessibility of mental health professionals, and perceived effectiveness of mental health care. Chi-square tests were conducted to compare responses by location (the United States vs international) and specialty (general neurology, subspecialist neurology, and neuropsychiatry).

Results: Significant differences in follow-up plans (χ² = 11.025, p = 0.026) and referral frequency for functional neurologic disorders (χ² = 24.943, p < 0.001) were observed, with US physicians more likely to comanage patients with mental health professionals. US neurologists also report referring patients with psychiatric comorbidities more frequently (χ² = 8.424, p = 0.038). No significant difference in the accessibility of mental health professionals was reported by location (χ² = 1.364, p = 0.968) or specialty (χ² = 2.939, p = 0.568). Neurologists in the United States were more likely than neurologists from other countries to perceive mental health professionals to be highly effective (χ² = 8.590, p = 0.035).

Discussion: Most neurologists favor integrating mental health services within neurology clinics, underscoring the need for better care coordination. Despite the global effort to integrate mental health in primary care, these findings suggest a need to consider alternative models in coordinating mental health care.