Primary care mental health nurse Shelley thinks there should be more roles like hers in GP practices to support those seeking help
Experts have reported that one in every four people seen in primary care will need treatment for a mental health problem at some point in their lives. And in light of the current pandemic, and the associated increase of stress, isolation, financial concerns and anxiety, this is becoming a growing concern.
For the majority of people, a GP would be the first point of contact when recognising concerns about their mental health. Unfortunately, primary care services have few, if any, specially trained mental health staff.
Given this growing acknowledgement of mental illness, the drive to encourage people to seek support and the current pandemic, I often wonder why more support isn’t available in primary care, where a person is most likely to first seek help.
For the majority of people, a GP would be the first point of contact when recognising concerns about their mental health
Despite ongoing efforts to reduce the stigma associated with mental illness, the worry and embarrassment about disclosing mental health concerns for the first time often remains.
A typical GP appointment is only five to 10 minutes long, providing little time to develop a therapeutic relationship or have a detailed discussion about stresses and situations which may have impacted upon a patient’s mental health and provide support. Appointments can often seem rushed and patients can be left feeling their concerns and difficulties are not significant or are dismissed.
The ambulance at the bottom of the cliff
Every interaction and appointment counts in building a patient’s confidence, especially when it comes to mental illness. The lack of support in primary care often brings to mind the saying “the ambulance at the bottom of the cliff”. With more preventative measures in place in primary care, at the top of that cliff, we could prevent so many from falling and needing acute services.
Over the past few years, I’ve observed the growing roles of specialist nurses within primary care, however it seems to me that mental health support on the whole remains absent.
During this time, I have set up and grown my role as a primary care mental health nurse within a GP practice in Norfolk.
With this specialist role in place, our practice is able to offer dedicated, longer appointments to review mental health concerns soon after they have first been raised, improving patient experience and willingness to discuss concerns. As the appointments take place within the patient’s own GP practice, they are predominately very close to their own home making access easy.
We offer dedicated, longer appointments to review mental health concerns soon after they have first been raised
When someone is experiencing mental health concerns, they may have difficulty engaging in conversation due to anxiety, dementia or limited language and understanding due to age. They may be significantly depressed with thoughts of suicide and struggle to trust another person, or they may be experiencing hallucinations which make it difficult to engage in conversation. Having this longer appointment time allows me to fully assess and accommodate a patient’s needs.
If I find a patient to be mentally unwell, they can be started on medication straight away, which can then be closely monitored for any side effects. This can reduce the potential need for a referral to secondary services or Wellbeing, a service that supports people with mild mental health concerns and offers cognitive behavioural therapy (CBT).
If referrals are required, they can be sent to the most appropriate service and supported at the earliest opportunity. I have developed my knowledge of community support services and therefore can encourage patients to contact specialist support services to meet their needs.
It may be that the person is experiencing mental and physical exhaustion from caring for a relative and would benefit from a full carers assessment. Historical abuse may be affecting their current relationship and support from abuse specialists may be required. The patient may need to be referred for CBT or to specialist mental health services if they’re acutely mentally unwell.
While awaiting secondary services, and then once discharged, I am able to provide support and ongoing monitoring of mental health and medications.
Having this opportunity to support patients at these early stages and provide continuity of care is really satisfying
The benefits of this role are huge. I often get comments that just having longer to talk, not feeling rushed and being heard is extremely helpful. As a mental health nurse, having this opportunity to support patients at these early stages and provide continuity of care is really satisfying.
Unfortunately, this type of role is few and far between. And with the ageing population and growing mental health needs of the community, I remain concerned about the limited level of support for mental health in primary care.
It is my belief that there should be access to specialist mental health support in all GP practices. This would undoubtedly make a significant impact on the longer term health and wellbeing of our patients and help ensure fewer people are left to rely on the ambulance at the bottom of the cliff.
