‘It’s good to talk’ – Managing Mental Health in primary care

Published: 6th May 2022
Dr David Griffiths is a practising GP and the Medical Director of Consultant Connect. In this blog article, Dr Griffiths writes about the benefits of specialist advice when managing patients with Mental Health difficulties.

Dr Griffiths writes about the benefits of specialist advice when managing patients with Mental Health difficulties.

As a GP, I’m known in my practice as someone who enjoys helping patients with mental health difficulties. I’ve written in a previous blog about the challenge of managing mental health issues in primary care and the benefits of advice from supportive secondary care colleagues. I also have a few reflections on what I’ve been seeing in recent times.

First, some data. The WHO tells us that they have documented a 25% increase in the global prevalence of anxiety and depression during the COVID pandemic.

UK data shows significant fluctuations in reported mental health among the population, seemingly linked to COVID rates and, probably, the national lockdowns. Among many stark pieces of data, they have seen high rates of thoughts of self-harm (>25% of adults report at least one episode between March 2020 and May 2021).

This does not surprise me and chimes with what we are seeing in practice. There are just so many potential negative factors affecting the mental health of our patients, not all related to COVID of course. These include, for example, changes to work and/or unemployment; isolation, stress, and fear of COVID; bereavement; financial hardship and food poverty; long COVID. And now we can add the anxiety of a war into the mix.

It has been well documented that General Practice is very busy at the moment. Supporting patients with mental health concerns takes time and can’t be rushed. Clearly, this is not a good combination.

I find that decision fatigue is a major factor in slowing me down in practice: it gets harder to make decisions as we get tired, and when workload builds, so does fatigue. Advice from specialists can be hugely helpful at any time but particularly when times are tough: as a GP I can benefit from new thinking on diagnosis, treatment, care pathways or alternative support options. Mental health is no different to other specialties in this regard.

Having said that, the decisions can seem more difficult sometimes, with the stakes being high and the stories having extra complexity.  An experienced psychiatrist can rapidly sift information about symptoms and behaviours to give helpful diagnostic advice, shed light on treatment choices e.g., medication interactions or augmentations, or provide useful collateral information from the secondary care records. I find this sort of constructive advice (and sometimes challenge) immensely useful and very efficient. I’m frequently surprised by how quickly we can get to the nub of an issue through conversation. As I said in my previous blog post and channelling my inner Bob Hoskins: it’s good to talk!

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