Longer trials are needed

EDITOR—The systematic review by Bower and Sibbald of on-site mental health professionals was a welcome addition to the literature on the effectiveness of the talking therapies in primary care.1 In view of the effect on consultation rates, prescribing of psychotropic drugs, and referrals to secondary care, the conclusion drawn was that the evidence for a direct effect was strongest in relation to general practitioner referrals to secondary care providers.

Six randomised controlled trials of direct effects on referrals were identified. Three were reported as showing referrals to be significantly reduced. Although some of the limitations of the studies were discussed, each of the six trials is flawed in terms of being able to generalise to everyday primary care

One trial was described as showing a significant reduction in referrals when the stated P value was 0.56, which is not significant.2 Furthermore, the therapy offered was from a psychiatrist based in primary care …