Mental health is core business for primary care

Sara Mosely shares results from a survey of 500 people in Wales who have sought support for their mental health from a GP

Mind’s ‘You and Your GP’ campaign aims to ensure that everyone with a mental health problem who visits their GP practice or another primary care service gets the support that best suits their needs. We know from our own research that mental health now accounts for 40 per cent of all GP appointments in Wales.   


This week we’re launching the results of Mind’s first Big Mental Health Survey, conducted at the end of 2017. We spoke to over 500 people in Wales about their experiences of seeking support for their mental health from a GP surgery over the past 12 months, to better understand what a good experience looks like, and what steps policymakers and healthcare professionals must take to get us there.


Primary care is much more than a gateway for mental health services; the majority of people who seek support with their mental health are only ever managed in a primary care setting, often having regular contact for medication management or treatment reviews.


Our health service is still primarily seen as a physical health service, and it’s not always obvious how we can re-design the system to reflect a more holistic attitude. Sometimes it’s as simple as a change to the basics of administration. More than half (52 per cent) of people who responded to our survey said they would prefer to book an appointment online if they had a choice but only 9 per cent booked their last appointment this way.


Despite the roll-out of My Health Online in Wales and many GP surgeries implementing an online booking system through My Health Online, our survey suggests that many people are unaware of the system, or their local practice has not yet fully implemented the system.


Almost half (44 per cent) of people were asked to explain the reason for their appointment when they booked it. Of these, 75 per cent were uncomfortable doing so. We need an approach to identifying the best support for patients that recognises stigma around mental health and the impact it has on people’s willingness to disclose their issues to multiple staff members, who are often strangers.


Once they arrived at their GP practice, 32 per cent of people felt uncomfortable in the waiting area. A number of factors could be making waiting room environments intimidating or unwelcoming to people experiencing poor mental health – for example, a reception located too close to seating to offer privacy. Engaging with patients on how practices are run could address this, but 82 per cent of people we surveyed didn’t have the chance to provide any feedback on their last visit to their GP.


It’s well recognised that a gold-standard mental health service must offer choice to people in the treatment they receive. Nobody disagrees that different types of treatment, such as medication, talking therapies or social prescribing can have different levels of effectiveness for different people. However, we don’t talk enough about reviewing what’s worked for an individual in the past, and asking if it’s still working.


Having a choice of treatment options isn’t just about what we’re offered on our first visit to our GP to talk about our mental health. Most people we spoke to had been receiving support from their GP practice for their mental health for some time; up to five years for 22 per cent of people and over ten years for 29 per cent. The rates of people being offered medication reviews or new prescriptions in recent appointments were significantly higher than rates of referrals for assessment by specialist services, talking therapies or services in the community.


Despite respondents largely feeling that the staff at their GP surgery took their concerns seriously and showed consideration for their mental health, our survey raises cause for concern on effectiveness of treatments. A quarter of people didn’t feel that the care they received at their GP surgery met their needs, and only a quarter reported that they definitely felt hopeful for the future. When large numbers of people are returning to their GP again and again for years, but not seeing an improvement in their health, we need to ask if that is good enough.


We heard loud and clear through our survey that many people aren’t getting the support they need because they’re not getting enough time to talk. More than a third (35 per cent) didn’t feel their GP/Practise Nurse took the time to find out about them as an individual in their last appointment, and a quarter (24 per cent) would have liked to discuss physical health issues in the same appointment, but weren’t able to.


The average GP consultation in the UK takes 10.6 minutes. We’re calling for longer appointment times to be offered for those with complex needs who feel they will need more than the standard 10 minutes to discuss their treatment.


In a climate of services under increasing pressure, it is a difficult ask. But when professionals have the time to find out about people as individuals – their lifestyle, their mental health history, wider health issues – this can support them to offer treatment options that are most likely to work for each person. This is turn can reduce prescription medications being the only choice presented, and can reduce the need for many future appointments. Some people with enduring mental health problems will need to keep going back to their GP for support for many years, but too many people have to keep going back simply because they haven’t found the treatment that works for them yet.


The 2018 Big Mental Health Survey is open now. You can share your experiences of mental health support here.


All articles published on Click on Wales are subject to IWA’s disclaimer.

Sara Moseley is Director of Mind Cymru

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