“we all have the same issues but if we are one big voice shouting it will get heard a lot quicker”  Karen McGuigan, STEPS

The beginning of June saw the kick off of a campaign by a coalition of mental health groups from across NI, under the umbrella of the Mental Health Rights Campaign, for improvements to mental health care from GPs.  Groups took action locally to highlight the publication of their campaign report ‘Beyond a Spin of the Wheel – Ensuring timely and appropriate mental health care from GPs’  

Awareness raising actions included delivering copies of the report to GPs and to MLAs, launching the report at a tree planting ceremony and activity by groups on social media. Groups secured significant media coverage including on Radio Ulster and Radio Foyle and in the regional press including the Derry Post,  the Impartial Reporter and the Andersonstown News.

The campaign report has emerged from work during 2016/17 by over a dozen mental health rights groups, including focus groups, questionnaires and workshops, designed to identify the key barriers encountered by people trying to access mental health care from their GP, as well as potential solutions.

The following issues emerged as the top three groups want to see addressed:

- Lack of mental health expertise among GPs

- Difficulties with getting GP appointments

- Over prescription of medication by GPs

- The lack of mental health expertise among GPs was identified as a major issue

- “I feel my GP surgery is very good most of the time but with mental health they struggle to understand and  they aren’t trained to deal with it”

People recognised that GPs currently have limited opportunities either during training or ongoing professional development to develop the expertise required. They also acknowledged that this lack of expertise was compounded by the ’10 minute’ appointment rule.

People’s experiences and observations are corroborated by information provided by the Health and Social Care Board to PPR.  A Freedom of Information response  indicated that only half of the annual cohort of trainee GPs have to undertake a placement in a mental health facility. The mental health charity Mind has highlighted the fact that practicing GPs are not obligated to undertake mental health training as part of their mandatory continuous professional development.

Difficulties securing an appointment when needed, coupled with lack of transparency around the appointment booking system were highlighted

“ we can only make appointments on a Monday, when you try to ring to make appointments the line is busy all day, by the time you get through there are no appointments left and then you have to wait until the next morning to try again”

While acknowledging that securing a GP appointment is a widespread one, the report noted that the impact on people with mental health problems can potentially be more serious and can serve to exacerbate an existing problem. The Royal College of GPs has repeatedly expressed its extreme concern at the soaring waiting times for appointments.

Finally, the over reliance by GPs on prescribing medication for mental health issues was highlighted by the research:

“ if people go in and say they are depressed, they write you a prescription, they don’t question anything, like how do you think things are, what would help you, it’s not like a conversation they have, it’s just like well here’s tablets , go ahead”

The long waiting times for psychological therapies were identified as one possible reason as to why many GPs rely on providing medication only for mental health problems “ many GPs end up prescribing drugs as the waiting lists are too long”.

The Mental Health Rights Campaign has put forward a series of potential solutions to the issues identified. These include:

- Mandatory mental health training for GPs and other relevant practice staff

- Other health professionals with the necessary expertise and skills to work alongside the GP

- A separate, designated phone line for making mental health related appointments with the GP

- Introduction of an ‘auto alert’ system so receptionists know a patient has mental health issues

- Longer appointment times including a default option of a double appointment for mental health issues

The urgency of addressing the issues identified by the campaign report is underscored by the facts and figures.  It is estimated that over 90% of people with mental health problems will be treated in the primary care system by their GP. However, according to the Royal College of General Practice NI, the region has the lowest GP coverage per head of population in the UK, as well as the lowest amount of spend of GP services.

The Mental Health Rights Campaign now intends to campaign for the changes outlined in this report and to monitor if and how people’s experiences of seeking help from their GP for mental health changes. In this regard the campaign looks forward to engaging with the Health and Social Care Board as the contracting body for GP services, as well as with GP representative bodies including the Royal College of GPsNI and the British Medical Association (NI) and individual GPs themselves.