Dr Jane Roberts, RCGP Youth Mental Health Champion, looks at the implications of a recent report highlighting unmet needs in the primary care of people with mental health issues.
The recent report by the Scottish Association for Mental Health (SAMH) (see page 8) has highlighted once more the growing challenges faced in general practice with regard to delivering appropriate care to patients with mental health issues.
The main problems are threefold.
First, there has been a serious shortfall of specific training in mental health for doctors, within both the medical school and vocational setting. Vocational training still adopts a “menu” approach where you pick your speciality (including general practice) out of a range offered. Training in mental health is not an obligatory part of this process.
Only about half of the GPs responding to the SAMH survey had undergone accredited training on any aspect of mental health within the last 12 months, while more than one in ten had never had any such training.
Figures from the Royal College of Paediatrics and Child Health also show that 30-40% of GPs have had no training in talking to children and young people – a worrying statistic in this context, since 75% of all mental health problems will have started by the time patients are in their early 20s.
As long as training for mental health and children and young people’s health is not a mandatory aspect of GP education, we will always have a situation where GPs are not adequately prepared or confident to deliver appropriate care to patients with mental health issues.
But as well as formal, mandatory training across the whole life cycle, we need a more integrated approach to mental health care and training so that GPs can understand more about what other professionals do in relation to supporting people with mental health needs.
The second problem is one of funding. If we are serious about endorsing the much vaunted “parity of esteem” for mental and physical health, then we have got to address the inconsistencies of the budget.
The RCGP has identified that 90% of all consultations are undertaken in primary care, and of those, well over a third will have a mental health component (in reality, almost all consultations will have dual aspects, because you can’t separate the mind and the body).
The budget for primary care, however, has not kept pace with increased demand and the recognition of this coexistence of mental health problems with almost all long-term physical problems. With less than 9% of the total budget currently allocated, we are a long way from financial parity.
The third challenge lies with commissioning of mental health services and the role of CCGs. Clinical leads need to be better supported in understanding mental health, so that they can work with local GPs and other providers to offer more tailored and creative approaches around mental health.
There is an increasing opportunity for services to be redesigned to provide a better and more appropriate mix of resources – not merely offering community psychiatric services, but also, for instance, working in conjunction with the voluntary care sector in each local setting to offer services which are much more likely to be taken up by hard to reach, disengaged patients.
The Association for Young People’s Health is espousing this innovation with a pilot “GP Champions” programme, in which GPs are working in partnership with charity youth workers.
Through these and other projects, we as GPs are making ourselves much more available for patients to present, very often in crisis with regard to social and mental health problems. But while access to services may be improving, there remain serious barriers to our ability to provide effective care.
You cannot have good health without good mental health, and this issue of parity is now well recognised. Unfortunately, however, the whole concept of parity has not yet translated into educational training which adequately prepares GPs for the prevalence , extent and rising complexity of mental ill health in primary care, or into service provision through funding streams.