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Home > Articles > Primary care and mental illness: a GP's perspective

Primary care and mental illness: a GP's perspective

GPs see patients from the very beginning to the very end of their lives and they come with every problem imaginable. Issues relating to mental health are amongst the most personal and sensitive that we encounter and understandably, there are times when it can be difficult for patients to share them.

One of the things that I sometimes feel holds people back from opening up to me as a GP might be apprehension of whether they will be listened to properly, taken seriously or treated sensitively. In fact, almost a third of all GP consultations touch on problems related to mental health, so patients really should be able to expect a caring response from someone with experience in this area, who should listen and act in their best interests.

Like an iceberg, there is a huge mass of mental health problems below the surface that goes completely unseen and untalked about.

If you were to take the residents of any street in Oxford, I really believe that people would be amazed if they knew what proportion have experienced some level of mental health issue.

90% of patients with mental health problems are cared for entirely in Primary Care (services based around a GP surgery, rather than a specialist clinic or hospital), although a variety of people often work together to provide this. While the GP may be the first point of call, where appropriate, they can then start involving other professionals, such as Community Psychiatric Nurses, Mental Health Practitioners, Psychiatrists, Psychologists, Therapists and Counsellors.

Even when patients are under the care of specialist psychiatric services, the role of the GP is an important one. They are well placed to get to know their patients over a period of time and advocate for them. They also co-ordinate other wider healthcare issues, which can easily become overlooked. With a huge overlap between mental health problems and physical illnesses (such as cancer and heart disease) this is crucial.

As a GP, my hope for the future is a community where less of the mental health iceberg lies below the surface and where people feel more able to share their own experiences.

They should feel comfortable that if they choose to do so, this will be met with sensitivity and care. This can only happen through a cultural change in our society and I believe that this is already happening. To build on this progress, however, it must be underpinned by an increase in funding for the care of people with mental health problems to reflect the huge number of individuals affected, the complexity of their problems and the devastating impact that these can have on the lives of patients and their carers.

In the words of the NHS Constitution, “The NHS belongs to the people”. If you feel able to share your experiences of mental health problems and the care you encountered, please do and make your voice heard. As healthcare professionals, patients and carers, we need to work together to help to crush any remaining taboos about mental health and to build on the service already provided. I am hopeful for the future.

This article was authored by Doctor Chris Longstaff, GP at Luther Street Medical Centre, Oxford.

Publication date: December 2012.

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