Primary Care Mental Health and Education
No mental health without wellbeing!
A primary care perspective on the Department of Health ‘No Health Without Mental Health: Implementation Framework’.
Although the 54 page document only makes half a dozen references to GPs as providers of mental health services, Dr Ian Walton, Chair of PRIMHE, the primary care mental health education charity, welcomed the Department of Health’s newly publicised strategy to implement the vision ‘No health without mental health’ at a Trustee meeting 27th July 2012.
It is clear that clinical commissioning groups (CCGs) bear a heavy responsibility. Aspiring CCGs will have to demonstrate that they have sufficient planned capacity and capability to commission for improved outcomes in mental health.
It is more than a decade since leading GP Andrew Elder and psychotherapist Jeremy Homes called for a new approach to mental health provision. They considered it ‘paradoxical that family doctors – who conduct more psychiatric consultations than any other group of professionals in the Health Service – are often not considered ‘mental health’ practitioners’.
Ten years on community based and GP-led mental health services are still the exception rather than the rule. This situation continues despite the economic case for integrating well-being approaches into the management of long term physical conditions and for primary prevention through public health approaches.
PRIMHE welcome the framework’s call for policymakers to take into account how physical and mental health are interconnected. The vision of ‘No Health without Mental Health’ was seen by many GPs as an opportunity for Elder’s whole-person approach to mental health thinking, ‘which places primary care – with its differences in emphasis and philosophy – as the base from which to build a fully integrated Mental Health Service’.
GPs know that acute and community services need to tackle the co-morbidity of physical and mental health problems, and ensure that clinical and other staff are able to spot the signs of mental ill health. Older people, either living in their own homes or in residential care, are especially vulnerable to mental health problems such as loneliness, isolation and co-morbid physical health needs which increase with age.
GPs are keen to see Psychological Therapies more easily available to people with long term physical health conditions and medically unexplained symptoms. GPs know how difficult it can be for community practitioners to access specialist support when required.
PRIMHE especially welcomes the framework’s recommendation that primary care practitioners should be aware of, and can help people access, the full range of services for people affected by mental health problems in their area. Given the emphasis, elsewhere in the NHS on a left-shift in service provision, it is good to see a reference to community-based support, parenting interventions, peer support, befriending services and similar. It is as well to remember that only a tiny minority of patients with mental health problems require formally commissioned mental health services.
PRIMHE also welcomes the framework’s call for improved training for GP. They would, however, like to add a note of caution. Whilst Psychiatrists are the acknowledged experts in specialist mental health, General Practitioners are experts in the management of complex multi-morbidity and dis-ease of uncertain aetiology.
While PRIMHE recognise that many GPs do need to improve their understanding of holistic case management, their skills in this area will not be improved by ‘innovative’ service models that take responsibility away from primary care. Even if this was clinically appropriate, it is economically unaffordable. Dr Ian Walton said ‘The document appears to see GP’s as passive recipients of the strategy rather than an active part of it. This is a concern. GPs will be answerable through CCG’s for the effectiveness of services even when the funding and commissioning of community services is held by local councils.’
GPs are uniquely placed to understand the local assets people need to support well-being. Working with community leaders in Sandwell , primary care practitioners, have shown that they can work to build resilience in their neighbourhoods. Sandwell’s innovative commissioning manager and PRIMHE Trustee, Lisa Hill expressed her concern that ‘the disease burden of depression is being offered an IAPT sticking plaster offered mainly by secondary care but not where the need is greatest in communities and primary care.’
She added, ‘The framework is just that; a skeleton. There is no meat on the bones and no investment or compulsion. Meanwhile there are huge cuts in local authority budgets that are impacting on people with severe mental health problems’.
PRIMHE believe that GP ‘training’ in mental health needs to be co-created in the communities they serve. It would be a tragedy if, while attempting to put mental health on a par with physical health, CCGs underestimate the capacity of GPs to become agents of change in the communities in which their patients live.
For more information about PRIMHE, the primary care mental health and education charity and its work to support GP education please see www.primhe.ning.com
Department of Health. (2011). No health without mental health: a cross-government mental health outcomes strategy for people of all ages.
Department of Health. (2012, July 24). No Health without Mental Health: implementation framework. Retrieved July 27, 2012, from National Framework to improve mental health and wellbeing: http://www.dh.gov.uk/health/files/2012/07/No-Health-Without-Mental-...
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