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, with 61 million antidepressant prescriptions administered in England in 2015.
The Royal College of GPs advise doctors to consider the mental health of a patient “in every primary care consultation”, and highlight the serious impact of mental health problems in contributing to disability, unemployment and social exclusion.
GPs have a key role in recognising and responding to patients’ mental as well as physical health needs but 2016 figures from the charity Mind show that in England, on average, only 46 per cent of trainee GPs undertook a training placement in a mental health setting. With demand continuing to rise, there is no better time to develop a special interest in this challenging field.
Entry and training
There are a number of ways to undertake training as a GP with a special interest (GPwSI) in mental health, both practical and theoretical. These are set out in detail in the RCGP’s Guidance and competences for the provision of services using practitioners with special interests: mental health.
- Experience of working in relevant departments
- Self-directed learning (with supporting evidence)
- As a GP specialist trainee undertaking a six-month specialist attachment
- Attachment to a mental health provider unit or under the supervision of a specialist practitioner
- As part of a recognised university training course.
Good communication and the ability to be empathetic and non-judgemental with patients, carers and colleagues are among the key characteristics for a GPwSI in mental health. Other skills practitioners may have include leadership/coordinating care, managing clozapine in the community, physical health monitoring and understanding the special needs of care relevant to special circumstances and special groups, such as:
- Elderly care and mental health
- Maternal and post-natal care
- Providing care within a custodial setting
- Management of delivery of mental health care
- Mental Health Act (Section 12) approval.
GPwSIs are expected to maintain their competences by keeping a personal development portfolio. It’s also recommended to work regularly within the specialist area to experience a varied case mix, be actively involved in local mental health specialist services, and contribute to local clinical audits.
GPwSIs in mental health may choose to work in a general practice setting but their skills can be applied further afield, such as in specialist medication clinics, residential care, prison healthcare, elderly care homes and other mental healthcare settings.
GPs have a key role in recognising patients’ mental as well as physical health needs.The type of care specialists can provide is broad and can include complex therapy for people with mental health problems and those with significant co-morbidities. This may involve areas such as eating disorders, pre and peri-natal mental health, early intervention in psychosis services and medical input to multidisciplinary primary care mental health teams. They may also help those with medically unexplained symptoms, treatment resistant symptoms, long-term medical conditions, and in older people’s mental health. GPwSIs can also provide specific psychological therapeutic interventions such as CBT, systemic or family therapy.
A block quotation (also known as a long quotation or extract) is a quotation in a written document, that is set off from the main text as a paragraph, or block of text.GPs with a special interest are often active in leadership and education roles, for example as a mental health champion within their own practice or wider community, and through sharing expertise with other primary care organisations or practitioners.
One of the key messages in the RCGP’s 2014 statement, Care of people with mental health problems, is that: “An exploration of physical, psychological, social, cultural and spiritual issues should be integrated into both the consultation and the management of illness; cultural issues can impact on how mental health issues present and the acceptability of diagnosis.”
Mental healthcare in primary care has been referred to as the “Cinderella of the health system”, but the signs suggest that change is afoot. Government policy seems to be placing a greater emphasis on mental healthcare provision, while in 2014 the RCGP made mental health and whole-person care a fiveyear UK-wide priority. The College says this move is “intended to encourage learning and development in mental health, as well as an environment in which quality improvement in mental health can flourish.”
- RCGP – Guidance and competences for the provision of services using practitioners with special interests: mental health
- RCGP 2014 statement – Care of people with mental health problems
- RCGP mental health resources
Q&A Dr Henk Parmentier, London-based GP with a special interest in mental health
What attracted you to mental health as a specialty?
Mental health is the most common “illness” in primary care so if, as a GP, you want to help patients, you need to be aware of mental health. Mental disorders are found in all countries, in women and men, at all stages of life, among the rich and poor, and in both rural and urban settings. Up to 60 per cent of people attending primary care clinics have a diagnosable mental disorder and 90 per cent of all mental health problems are looked after in primary care. Only about 25 per cent of all people with mental health problems receive ongoing treatment and most chronic illnesses are co-morbid with mental health problems like anxiety and depression.
What does your role involve?
Seeing patients who are referred to me by my GP colleagues in the surgery where I work. I also run a specialised mental health/wellness clinic for the local GP federation. I organise educational events and lecture to clinicians about mental health.
What do you enjoy most about the job?
Seeing my patients and lecturing.
Are there any downsides?
There is a risk of being too much focused on mental health issues.
What do you find most challenging?
Closing the gap between primary and secondary care is a challenge. Another is reducing the excessive mortality for patients with a mental health illness: people with conditions like schizophrenia, bipolar disorder, and major depression die, on average, 25 years sooner than those without mental health problems.
What about the role has most surprised you?
How with simple advice and interventions you can improve health so much.
What is your most memorable experience so far?
Seeing how over time a homeless alcoholic person returned to being an independent person with a meaningful job, living by himself.
What advice would you give to a trainee GP thinking about specialising in mental health?
Do it! Primary care mental health is the only “special interest” that will help most of your primary care patients both with physical and mental problems.
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