I work in a largish, semi-rural training GP practice in Essex. During one day on call last week, I saw 40 patients face to face, and 15 of them had mental health problems.
They included a suicidal young man; several depressed patients with physical symptoms that secondary care investigation could not identify a cause for; a victim of domestic violence; a child affected by their parents' anxiety; a schizophrenic patient with health complications; and a relapsed class-A drug user.
This is not unusual - about 30% of any GP's workload relates to mental health.
I feel real frustration that patients' needs are not being recognised, diagnosed and getting evidence-based treatment speedily and early enough to have a good effect. In A&E, someone with palpitations but having a panic attack will get lots of physical investigation but may not be accurately diagnosed with anxiety and referred for therapy. The likelihood of a young person presenting with self-harm receiving the correct treatment is minimal.
Suicide rates are rising among young people, and among men in general, especially in middle age. People with severe, enduring mental illness die 20 years prematurely due to poor lifestyles and lack of access to physical healthcare. Figures like these are what led me to become a GP mental health lead, to chair Mid Essex Clinical Commissioning Group, and become clinical director for the East of England Strategic Clinical Network.
We need new models of physical and mental health care, but there is now real political will to provide those and achieve equity in funding for them. It will take several years, but the good news is, things are beginning to change.
I am particularly proud of the four pilot "zero suicide sites" in the East of England set up 18 months ago as everyone involved wanted to make a difference with suicide prevention. The work is based on the Perfect Depression pathway in Detroit, which has achieved a zero suicide rate for 11 years in a very deprived part of the USA. The interim evaluation of this project can be seen on this link: www.centreformentalhealth.org.uk/zero-suicides.
Community awareness and reducing stigma have been a big part of this, and attracted amazing support from many organisations and individuals in the pilot sites. One example is the Stop Suicide website, www.stopsuicidepledge.org, which has had international hits. Coroners have become highly involved; suicide hotspots have been removed; and GPs, nurses, paramedics, secondary care staff and emergency services have received mental health training. The initiative now has government support, with new trials in south-west England and Merseyside.
Other areas of national work are beginning to have a real impact on how we deal with distress and illness. The Crisis Care Concordat has multi-agency support, and some impressive results. In Essex, "street triage" - a scheme seeing a mental health nurse out on patrol in police cars - has already shown impressive results. No child with mental health issues has been held in a custody suite for four months, now - instead being supported in the community during a crisis.
We are looking to broaden access to support for vulnerable people and families, and to develop 111 as a 24/7 point of contact for people, providing staff with mental health training so they can signpost callers to essential services.
Our work on long-term conditions, frailty and social prescribing means staff can identify people who need treatment for anxiety, depression, or psychosis and refer them to it. Social care, finance, debt and accommodation have a huge part to play in recovery, and in Essex we want recovery-based education and training courses co-produced by service users.
In addition, more funding for children's wellbeing and mental health services is coming. The Future in Mind report, with a focus on perinatal mental health, will see primary and secondary schools adding mental health to their curriculum, support and training for teachers and access to support for young people within schools at an early stage.
We are investing in developing the workforce around Improving Access to Psychological Therapies (IAPT) for children and young people, and outcomes-based approaches to check on our interventions' effectiveness. We want more people accessing adult IAPT, but celebrate the support it already gives - in our area of Mid Essex, of the 6,500 people referred to IAPT (about half self-referring), 5,000 have entered treatment over the past 12 months. More than 90% are then accessing treatment within six weeks, many much earlier.
Very excitingly, there will be two-week wait to start treatment of eating disorders, based on national models of care, so a very vulnerable group with high mortality rates can be seen much earlier, improving outcomes for them considerably.
If people with psychosis receive evidence-based intense support within two weeks of diagnosis, they are likely never to have a further episode, and 45% of them will achieve full employment compared to the current 7% in England. There will be improvements in the skills of community teams who support them to achieve this.
Access and waiting time standards for a range of conditions are coming, particularly for "talking therapies" in secondary care. Current waits of two years must come down to 18 weeks, a huge improvement for patients.
We need to move away from separating physical and mental health conditions - the brain is the most important part of the body. Mental health patients should expect the same level of diagnosis and care within their GP practices as they would do with any other condition.
There is so much to do, but at last we are on the brink of a real revolution for our communities in integrating physical and mental health care - and most importantly, taking a preventative approach.