It seems like common sense that the first place someone with a health problem is likely to turn for help is their GP, who is expected to deal with them in an appropriate manner. For people with mental health problems, however, this isn’t necessarily the case. According to the anti-stigma campaign Time to Change (TTC), many people experiencing mental distress arrive at the GP surgery to find that primary care professionals are ill-equipped to deal with their needs. Sometimes the sheer volume of work GPs must contend with means there aren’t the resources available. But often a lack of awareness and training about mental health issues means patients do not receive the care and attention they need.
To tackle the issue, the organisation developed a pilot project to raise awareness among GPs, nurse practitioners and other primary care staff on how to improve their services. Launched in October 2012, the Time to Change Primary Care Project came to an end recently and, according to the practitioners and service users involved, has made considerable headway in changing attitudes among clinicians and support staff.
“I’ve had a lot of experiences with GPs’ surgeries,” says 25-year-old Rebecca David, who has been using mental health services for depression and anxiety since her teens and is involved with the TTC initiative. “Many times it just felt like box-ticking. I would be given forms to fill in [and] it didn’t feel like [doctors] were really listening. In some cases they are overwhelmed [with work] but that doesn’t make it okay.”
David, a musician who works as a freelance trainer for mental health charities, signed up to the TTC pilot to train GPs to better understand service users’ experiences. She took part in a number of 10-minute, one-to-one sessions with frontline staff (more than 500 health professionals participated in total) in practices in London, Liverpool and north Staffordshire. “In all the practices I went to, the GPs said they would aim to change the way they worked,” David said. “They realised that they could improve things without adding to their workload – really simple things like making sure people are signposted to community mental health services and simply listening. It often takes a lot of courage just to go and talk to a doctor and it’s not an exaggeration to say that if the service is poor it can have a profound effect on someone’s future.”
Sidney Millin, another “involvement worker” with the project, echoes David’s assessment, saying that while he encountered “some reluctance”, he too saw GPs and other staff react positively to being better informed. “A lot of time GP surgery staff have got this misconception that people with mental illnesses are always ill – they cannot communicate, they cannot speak and they cannot function normally. So this is kind of busting that myth.”
A former journalist, originally from Zimbabwe, Millin has bipolar disorder and has had some difficult interactions within primary care. He talks of how when learning of his diagnosis, one GP “had an alarmed look on her face” and kept the door to the consultation room open whenever he was there. “It was a time when I was not so comfortable talking about my diagnosis so I didn’t complain. But it made me feel bad.”
Alan Hollinghurst, a former head teacher and mental health service user involved in the project, says: “The aim of the project is to raise awareness about mental health within primary care. As a service user I feel I can speak with authority because I am actually telling my own story.” A few “small adjustments” can go a long way, he adds. “If [people] get treated right straight away it can make such a big difference to their recovery.”
An evaluation by the Institute of Psychiatry published in April showed a reduction overall in the stigma and discrimination experienced by people with mental illness but it also found that negative attitudes among health professionals had not improved. Sue Baker, director of Time to Change, says that while there is evidence of attitudes shifting across society, “there is not the same rate of change among health professionals”. The pilot project (it has an online resource that GPs can access too) is an attempt to provide “a tailored intervention” that recognises how “people with lived experience” can work with primary care staff to bring about improvements. “GPs have been openly saying they don’t get enough training on [mental health]. There is definitely an appetite for this.”
According to Baker, one of the main advantages borne out by the pilot was that change was achievable without being “burdensome” to overstretched professionals. Feedback following the pilot found that while 46% of GPs said they were confident about identifying the signs of mental illness before the training, this jumped to 64% afterwards. In addition, 64% said they were better equipped to make adjustments so that people with mental health difficulties could access their practice as opposed to just 41% before.
Baker says TTC has been “working closely” with the Royal College of General Practitioners and is hoping the model used during the pilot can be rolled out around the country. It is especially important, she suggests, because GPs are reporting that more people are coming to them with mental health problems. Dr Catherine Roe, one of the GPs who participated in the initiative, says at first she and her colleagues were “intrigued” by the idea of 10-minute sessions but that they were impressed from the start. “We were able to fit it into our normal working day which was a great help. If they wanted to, I could see this being rolled out to other primary care settings,” she adds. “The point to really stress is that most mental health problems are dealt with within primary care and we don’t always do it very well.”
Roe says more people with mental health problems have visited her surgery in recent months, making it more important to be attuned to individual needs. Another GP, Dr David Abraham, agrees: “Mental health problems are a major part of our workload and unfortunately in this part of the world, and at these economic times, and for all sorts of reasons, we have an increasing workload related to mental health.”
He adds: “It is difficult for some people to use the practice when their mental health is not so good and we don’t always consider that as much as we would like to. If the atmosphere in the practice is universally accommodating and understanding then it’s likely the outcomes for the patients will be better.”
