A THIRD of GP consultations involve mental health – how does this impact practices?

Published: 21st February 2018
One in four people will experience a mental health problem in any given year, research suggests, with 90 per cent of those making primary care their first port of call for help. It is not surprising, then, that as many as a third of GP consultations involve a mental health component. Our Mental Health Lead, […]

One in four people will experience a mental health problem in any given year, research suggests, with 90 per cent of those making primary care their first port of call for help. It is not surprising, then, that as many as a third of GP consultations involve a mental health component.

Our Mental Health Lead, Jenny Welling-Palmer was keen to discuss the impact of these staggering facts with practising GP, Dr David Griffiths who is also our Medical Director…

Do these stats ring true in your experience?

Yes, this is definitely true for what I see on a daily basis in general practice.  I don’t see patients with a serious mental illness all that frequently (they tend to be managed in secondary care), but I see a lot of people with low to medium grade mental health problems, in which I would include loneliness, misery and stress; it’s people’s life experiences that affect their mood and thinking. I also see a lot of people whose stress affects their physical health.

What does your practice do to support people with mental health problems?

In addition to GP appointments, we have a counsellor that works in the practice, who is employed through the local IAPT (Improving Access to Psychological Therapies) service. We also have a practice care navigator who can recommend and access services across health and social care, and within the community.

What are the most common mental health problems?

People present with mental health problems across every age; from pre-teens with conditions such as ADHD and anxiety, into the teenage years where eating disorders and depression become more common. I’m seeing more and more adults present with personality disorders and I don’t know if this becoming more common or just being diagnosed more frequently. In older adults the most common conditions I see are anxiety and, of course, dementia, which often co-exist.

Quite a few of my patients comment that they’ve had previous poor experiences with secondary care so would rather be seen and managed within primary care. That may reflect the importance of continuity; it is probably a bit easier for us to provide that.

What frustrates you the most about mental healthcare in the UK?

Local services have been starved of cash. In austerity-driven times it is hard to support the people who need it the most; those people who have had difficult lives and therefore have poor coping strategies. These people are waiting an incredibly long time to gain access to the services they need, such as group therapy and support to get off medication. There are many people who don’t cleanly fit into existing pathways so bounce between services and, all too often, fall through the cracks.

How do you think primary care can better support people with mental health problems?

Primary care can always get better – we should be more flexible and focused on holistic care, treating the whole person. There is too much variation between practices in supporting people with mental health problems. GPs shouldn’t shy away from difficult patients but ask themselves what they can do to help, and how they can engage them. Often this won’t be through the traditional method of a patient to GP pre-booked consultation.

In fact, non-GPs and, often, non-clinicians may be best placed to offer support – for example, through social prescribing – and yet the GP surgery is still a great place to offer this sort of advice. In addition to this, in Oxford we can call a special Mental Health Advice & Guidance* line to get secondary care help.

When do you use the Mental Health Advice & Guidance line?

I tend to call the line for advice when I feel I’m not helping a given patient progress, usually for advice on management options, which can include both medication and therapy.

It’s really useful to have a quick conversation with a specialist. I recently called about a complicated case. My patient was keen to change her antidepressant and I was worried about potential interactions with the various other drugs she takes for her mental health condition. The consultant was able to reassure me that the new combination should work synergistically and have a greater effect than her existing regimen, something I had been unable to find by searching the literature.

With mental health issues, I find it particularly helpful to be able to have a conversation. There is almost always information which I would not have thought to put into a letter or email and which the consultant is able to use to guide decision making.

What does the NHS do well to help people with mental health problems?

Fundamentally, whoever walks into a GP surgery is offered care. If you put barriers in front of people, some won’t access care and, often, they will deteriorate because of that. General practice is good at managing low level mental health problems; those clinical conditions that both cause and are caused by unhappiness, as well as more serious conditions. Social prescribing is now an established approach which I use in my clinical practice. I also coach patients to help them unlock their own solutions, which is an area I see growing in primary care. GPs can play a valuable role in coaching their patients as a method of clinical support.

What vision do you have for the future of mental health care?

I would like to see a change in the culture of our society that puts happiness and mental wellbeing at the heart of everything, after all, what is more important than that?  I believe that government is duty bound to tackle the social determinates of mental ill health and I think we, in General Practice, can be at the heart of communities who want to support the lonely and vulnerable.

*Consultant Connect has been proving a Mental Health Advice and Guidance service for GPs in Oxford since 2016.

If you are interested in finding out how our service can help Mental healthcare provision in your area, please contact us on 01865 261 467 or email hello@consultantconnect.org.uk.

Related article:

5 ways clinicians can work together to improve Mental Healthcare

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