Mental health care and general practice are in deeper crisis than ever before. We need a political solution.
Amid claims that GPs are “hiding” from patients behind telephone triage and e-consultations, I feel compelled to show you a glimpse of “The Other Pandemic”. Falling squarely at our feet overspilling our appointments: mental health.
In March a survey of over 4,000 people in the UK established that “there is a genuine, wide and profound mental health crisis.” The appointment list for my day’s surgery supports the assertion.
GPs have always managed the majority of mental ill-health in the UK. One surprising positive to come from the pandemic, is that talking about mental health is losing its stigma.
At the start of the pandemic, even the worst affected tried to hang on, to give us the time and space we needed to deal with Covid. Those who did come were already in crisis, desperate, having held their breath for too long.
After the first lockdown the floodgates opened, and over a year and a half into a pandemic that seems destined to continue indefinitely, every day brings more new patients.
Mental health services were already creaking pre-pandemic. Community mental health teams provide good, if slightly slower, access to talking therapies for those too ill to access the voluntary sector service, and a crisis team that can react to offer support in a timely way to patients at risk of suicide.
But what they can’t offer, is medication. That needs a psychiatrist; the adult psychiatrist for my particular area has been unfilled for months. If I think patients need more than an anti-depressant, or an adjustment of anti-psychotics, then we must wait until the situation becomes urgent enough to warrant a review by the psychiatrist from a neighbouring area.
With clear evidence that severe mental illness is best nipped in the bud, preventing both long term illness and recurrence, that can’t possibly be an adequate service for our patients.
Child mental health services fare no better. Child and Adolescent Mental Health Services (CAMHS) have a reputation for being impossible to access at the best of times. They are the only service GPs refer to who routinely “bounce” referrals back, without even seeing or assessing the patient. With disruption to schooling, uncertainty about exam formats, isolation from friends, fear of illness and loss of loved ones, the mental health of our children is suffering, and the service has been overwhelmed.
Even those children who clearly meet the referral criteria are waiting months to be seen. As a GP there is little I can offer here, except monitoring and general support.
I find myself seeing a child and her clinically vulnerable parent monthly, tracking her increasing anxiety, her flattening mood, the total insomnia worsening to the point of hallucinations. A change that means I can write a letter to expedite the appointment, and six weeks or so later, an assessment happens. I continue to check in with her while she waits again, this time for therapy.
I know just enough about this highly specialised area to be aware that my inexpert input could cause more harm than good; regularly opening a box of unhappiness she may have naturally put a lid on, without being able to help her make sense of the contents, balanced against the risk of not knowing whether she is deteriorating, or how deep that deterioration has gone.
Other regulars include a small cohort of new mums, mostly presenting too late after the birth for the narrow referral window of our perinatal mental health service. Isolation and lack of support has hit hard at a time when sleep deprivation, hormones, traumatic experiences, pain and disillusionment coincide to create a perfect psychological storm. I do my best, but notice that those who can afford private therapy seem to recover faster and more fully.
Another, larger cohort, are the patients with health anxiety. Something that has affected almost all of us to some extent, during the biggest health crisis of our time.
Amongst the onslaught of unmet need, we must sift through those whose anxieties about their health are irrational, and identity those who may have been sitting on a serious physical problem for too long. Both need addressing and often both can occur within the same patient. With delays in secondary care diagnostics, and now a national shortage of blood test tubes, we are working in a minefield.
Working at this intensity, among so much distress and without an end in sight, is starting to take its toll on our profession. In April mental health service NHS Practitioner Health announced they were taking 22 per cent more self-referrals from GPs than pre-Covid – myself included.
Mental health care and general practice are in deeper crisis than ever before, and this needs a political solution. There is an opportunity here to open a conversation and with investment, to create something outstanding. We just need to demand it – please write to your MP to do this.
In the meantime, keep trying if you need to see us, and remember that GPs are human too, so please be kind.
Dr Louise Hyde is a GP and member of the Doctors’ Association U.K.
