Mental health – government proposals and what we can do to improve the patient experience
GP Aisha Yahaya asks if the government's plans for mental health are achievable
Mental health has been much in the news recently – and with good reason. 1 in 4 of us will develop a mental health problem in our lifetime and 20% will experience some form of depression. As GPs, we are all aware of the pressures on mental health services in the UK. A recent BBC article wrote that ‘Poor mental health care ‘ruins lives’, alluding to the fact that mental health services remain underfunded despite being in increasing demand - much like the rest of the NHS.
In a health system that is already stretched, how does the government propose to address the inequalities in mental health care and what can we do as clinicians to provide the best care for our patients?
With a quarter of people who have committed suicide having been in contact with a health professional (in most cases their GP) in the week before they died, the pressure on us as the current gatekeepers to mental health services is immense.
The government has pledged an extra 1 billion pounds in investment towards mental health. This aims to cover the cost of greater access to talking therapies, place mental health teams into all A&E departments, provide more perinatal support and also for children, nationwide access to community crisis care teams and the reduction of suicides by 10%.
This is all part of creating a 7-day mental health service where people have access to help at any time, aiming to achieve this by 2021.
A report produced by the Independent Mental Health Taskforce also mentions the importance of looking at physical and mental health in unison. There are 490,000 people with severe mental illness registered with a GP in the UK, of which between 62 to 82% are receiving annual physical health checks. GPs are well aware that people with mental health problems are more likely to demonstrate harmful lifestyle behaviours such as smoking and excessive alcohol intake. It is paramount, therefore, that they undergo regular monitoring of their physical health. GPs are being called upon to provide this service.
What support is there for GPs to implement the proposed changes?
The Department of Health and NHS England want to ensure that by 2020/21 all GPs receive core mental health training, including the 5000 extra GPs they wish to recruit to provide a 7-day GP service. They also propose to develop more GPs with an extended practice in mental health.
A recent King’s Fund report on ‘bringing together physical and mental health’ outlined initiatives such as joint psychotherapist/GP consultations to help people with complex needs. This has been shown to bring about a reduction in GP attendances by these patients. Other strategies include shared care models with multidisciplinary hubs that address different aspects of a patient’s problem.
In terms of physical health checks, QOF had financially incentivised them until 2014. Certain areas of the UK developed electronic templates to help facilitate this, which meant their rates of people with mental illness receiving physical health checks was higher than in other areas.
While no doubt some GPs would welcome an electronic template to enable these checks to be done quickly and accurately, would it just add to the plethora of other mindless tick box exercises that already exist?
It seems as though there are many proposals without clear plans as to how they are to be implemented. The contentious plan to expand the GP workforce should in theory give us the capacity to be able to fulfill the increasing expectations set upon us but I wonder how realistic it is.
What about our own personal attitudes?
As doctors, we must ask explore our attitudes towards mental health. Are we equipped with the unfaltering empathy and understanding to help patients who come to us seeking it. Do we recognize colleagues who are struggling and show them the same support we show our patients or are we skeptical about the validity of their feelings?
Encouraging open dialog within families and other social groups is also key to increasing understanding of this much-stigmatized problem. We should do our best to explain aspects of mental health to family members who are struggling to understand what their loved one is going through. We can also make use of the great organisations who champion mental health such as Mind, Rethink and YoungMinds.
The task is a mammoth one, but with the right support, I still believe we can make positive steps towards improving the experience of our patients with mental health problems.
