Beyond a Spin of the Wheel – GPs and mental health care

The crisis facing GP services in Northern Ireland has been well documented, including in previous posts on Slugger O’Toole.  Increasing patient lists, ‘red tape’, underfunding, an ageing workforce and the compounding of health issues in deprived communities due to austerity policies, are only some of the problems faced by the service. The British Medical Association has mooted the unwelcome spectre of GPs walking away from the NHS, while the Royal College of GPs NI, in an open letter, has highlighted the growing waiting lists and plummeting morale among GPs. On an almost weekly basis there are media reports of GP practices under threat of closure. In Fermanagh for example it is predicted that almost half of GP practices in the county will close within a year.

We know what the impact of all of this is on GPs, both personally and professionally, but what of the impact on patients? And what about those patients seeking help from their GP for mental health problems?

GPs are the entry point to primary care and over 90% of people with mental health problems will be treated within the primary care system by their GP.  People experiencing mental health problems have a fundamental right to be able to access both timely and appropriate mental health care from their GP.  On average at least a third of all GP consultations relate to mental health problems. In deprived communities this ratio will be even higher, where rates of mental ill health are double the regional rate.  In a society where rates of mental ill health and suicide are going in the wrong direction, the critical importance of getting primary care services right for people experiencing mental ill health hardly needs to be pointed out.

Yet the harsh reality of people’s experiences in 2017 is very far from the standard of care they are entitled to expect. A new report, produced by the Mental Health Rights Campaign, a coalition of mental health groups across Northern Ireland, documents those experiences in some detail. It doesn’t just stop there however. It also identifies the key issues underlying these experiences and proposes a range of solutions to improve things.

The campaign report is entitled ‘Beyond a Spin of the Wheel- Ensuring timely and appropriate mental health care from GPs’ and was published in early June with the support of human rights group PPR ,  to mark the launch of a campaign to improve mental health care from GPs. The foreword for the report was written by Dr. John Kyle, the well-known East Belfast GP and PUP Councillor on Belfast City Council and contributor to Slugger.

 

Three issues were identified as top priorities for change, as follows.

• Lack of mental health expertise among GPs

The lack of mental health expertise among GPs was identified as a major issue

“I feel my GP surgery is very good most of the time but with mental health they struggle to understand and they aren’t trained to deal with it”

People recognised that GPs currently have limited opportunities either during training or ongoing professional development to develop the expertise required. They also acknowledged that this lack of expertise was compounded by the ’10 minute’ appointment rule.

Those experiences and observations of patients and carers are corroborated by information provided by the Health and Social Care Board to PPR.  A Freedom of Information response  indicated that only half of the annual cohort of trainee GPs have to undertake a placement in a mental health facility. The mental health charity Mind has highlighted the fact that practicing GPs are not obligated to undertake mental health training as part of their mandatory continuous professional development.

• Difficulties with getting GP appointments

Difficulties securing an appointment when needed, coupled with lack of transparency around the appointment booking system were highlighted

“ we can only make appointments on a Monday, when you try to ring to make appointments the line is busy all day, by the time you get through there are no appointments left and then you have to wait until the next morning to try again”

While acknowledging that securing a GP appointment is a widespread one, the report noted that the impact on people with mental health problems can potentially be more serious and can serve to exacerbate an existing problem. The Royal College of GPs has repeatedly expressed its extreme concern at the soaring waiting times for appointments.

• Over prescription of medication by GPs

Finally, the over reliance by GPs on prescribing medication for mental health issues was highlighted by the research:

“ if people go in and say they are depressed, they write you a prescription, they don’t question anything, like how do you think things are, what would help you, it’s not like a conversation they have, it’s just like well here’s tablets , go ahead”

The long waiting times for psychological therapies were identified as one possible reason as to why many GPs rely on providing medication only for mental health problems “ many GPs end up prescribing drugs as the waiting lists are too long”.

Potential solutions put forward by the Mental Health Rights Campaign include:

• Mandatory mental health training for GPs and other relevant practice staff
• Other health professionals with the necessary expertise and skills to work alongside the GP
• A separate, designated phone line for making mental health related appointments with the GP
• Introduction of an ‘auto alert’ system so receptionists know a patient has mental health issues
• Longer appointment times including a default option of a double appointment for mental health issues

The Mental Health Rights Campaign now intends to campaign for the changes proposed in their report. The Health and Social Care Board, as the contracting body for GP services, must play a lead role in bringing about the necessary changes.  While, as pointed out by Dr. John Kyle in his foreword to the report ‘greater financial investment is unavoidable’, not all of the proposed solutions are necessarily costly in monetary terms. The longer term benefits, both human and economic, of ensuring that people with mental health problems receive timely and appropriate care from their GPs will be immense.

The Mental Health Rights Campaign is keen to hear your views on the findings and recommendations set out in its report. You can contact the campaign by telephone 90 313315,  email [email protected] or via facebook

Sara Boyce is a Development Worker ( Mental Health) with PPR (Participation and the Practice of Rights)