Dr David Griffiths is a practicing GP and the Medical Director of Consultant Connect. In his latest blog, Dr Griffiths writes about how Mental Health impacts his work as a GP.
Approximately 1 in 4 people in the UK will experience a mental health problem each year1, and 1 in 6 people in England report experiencing a common mental health problem (such as anxiety or depression) in any given week2. With this in mind, it is no surprise that working as a GP, mental health is a key part of my job. There are numerous reports and statistics on the topic, to highlight a few:
- 40% of GP consultations relate to mental health problems3
- In 2014, a total of 12.5% of people reported talking to their GP about their mental health4
- 30% of people with a long-term physical health condition also have a mental health problem4
These figures absolutely fit with my personal experience. Mental health issues are everywhere, and with the reduction in living standards seen in recent years, my sense is that this workload is rising significantly.
Challenges for GPs dealing with Mental Health patients
The challenge for GPs is that the job can sometimes feel surprisingly isolated. This is because GPs don’t always have time for clinical discussions and peer support. And caring for patients with mental health issues is a huge part of the role of a GP but also one of the most challenging. There are many reasons for this, including:
- Anxiety about managing risk (and being blamed if things go wrong)
- A lack of options for onward referral / support, particularly wider community options
- The complexity of managing co-existing mental and physical ill-health
- The higher risk of side effects with mental health drugs and the challenges of polypharmacy
Thinking back over my own experiences, particularly in the past couple of years, I can see certain patterns emerging in terms of what things I find challenging, including:
- Diagnosis, for example, can be tricky, particularly with the rise of the Personality Disorder (PD). These patients are also tricky to help because of the lack of support services and the fact they require long-term strategies which are hard to implement in 10-minute aliquots of GP consultation. I have had some excellent coaching conversations with colleagues from the mental health team who have helped me develop my strategy for specific patients.
- Medication decisions are made more complicated by the number of people who are already on a mixture of medications – especially those who have depression and chronic pain or conditions like Parkinson’s Disease or dementia.
- Patients with suicidal feelings are also concerning and it’s not surprising that I can think of a few cases recently where I have been anxious to speak with others and test out my thinking.
In all of these situations, it can be extremely helpful to discuss the case. I regularly do this with my GP colleagues and, unsurprisingly, they have similar concerns. It is therefore fantastic to be able to test ideas and ask questions to colleagues in secondary care. There is more than one way to do this; I sometimes send emails or letters asking for advice, where there is no particular urgency.
Immediate two-way communication
However, I do think that it is easier to discuss these cases by phone, where the two-way communication means we can get to the heart of the matter more reliably. I find it helpful to be able to push back, to constructively challenge the advice and to develop a plan in collaboration with a specialist.
As I reflect, I realise that I am considerably more confident with these scenarios than I used to be. I have developed my consultation skills and my management approaches over the years. I remember well how anxious I felt as a newly qualified GP and I can think, even now, of unnecessary referrals I made, which didn’t help me or my patient. Clinical discussions are a massively important part of clinician development and training as well as a key element of good patient care.
As they used to say in the adverts, ‘It’s good to talk’!
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1 McManus, S., Meltzer, H., Brugha, T. S., Bebbington, P. E., & Jenkins, R. (2009). Adult psychiatric morbidity in England, 2007: results of a household survey. The NHS Information Centre for health and social care.
2 McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (2016). Mental health and wellbeing in England: Adult psychiatric morbidity survey 2014. Leeds: NHS digital.
3 Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossy, M., & Galea, A. (2012). Long-term conditions and mental health – The cost of co-morbidities. London: The King’s Fund, & Centre for Mental Health
4 Lubian, K., Weich, S., Stansfeld, S., Bebbington, P., Brugha, T., Spiers, N., … & Cooper, C. (2016). Chapter 3: Mental health treatment and services. In S. McManus, P. Bebbington, R. Jenkins, & T. Brugha (Eds.), Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital.