THE BLOG

A GP's Concern About The Lack Of Mental Health Services

23/05/2017 18:00
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Mental health has no boundaries. It affects the rich and the poor, the most famous to the unknown. In 2014, Robin Williams succumbed to an illness that resulted in him taking his own life. This week, Chris Cornell, the great rock legend, joined the growing list of stars whose departure from this world is rooted in mental health. A number of campaigns endorsed by celebrities and influential people have been launched, illustrating that mental health affects people from all walks of life.

The Royals have recently endorsed the 'Heads Together' campaign to help give voices to those who have none. Having suffered such a great personal loss, the Princes, as children, walked behind their mother's casket with the eyes of millions upon them. The only privacy they had were their feelings, feelings they have now begun to share openly with the hope of removing stigma and making others seek help.

There are already reports of a surge in the number of people accessing the service and if this continues then they have done very well. However this is only half the battle. As a GP, I am slightly apprehensive about an increase in patients seeking help. When they attempt to see their GP, they will most likely be told that there is a three-week wait and once seen, I fear there are limits to what we can offer them.

Over the last few years I have found that it has become extremely difficult to access the mental health service in my area. Referrals are regularly rejected due to varying levels of bureaucracy. If patients are acutely unwell they would need to go to Accident & Emergency. In such a vulnerable state I am often left wondering if the patient will get there or even wait to be seen. Not long ago, I phoned the mental health service to get an urgent appointment for a suicidal male teenager. The first available appointment was six weeks away and when I expressed the urgency of the case I was told "everyone's suicidal".

My practice called a meeting with our local consultant psychiatrist to discuss our concerns. He informed us of the drastic cuts to his service that involved one of the three consultant posts being terminated, in addition to all middle grade/non-training doctors. Outpatient clinics had been closed down, hence all chronic patients had been discharged to their GP. There were only three people employed to review all the local referrals to the service, with no cover during sickness or leave, and they were triaging over a hundred referrals per day.

I perhaps naively hadn't appreciated that NHS reorganisations and cuts could deplete a service to the point of loss of doctors and complete closure of an outpatient department. Just as any organ in our body can have a chemical or pathological abnormality, the mind can also be affected. So how did we get to a stage where a whole specialty in medicine is deemed unnecessary? And where does that leave my patients?

With the mental health service functioning in a deprived state, we as GPs will have to fill in the gaps. Regardless of whether we have the appointments to accommodate this, do we even have the skills? And can we safely evaluate risk in a 10-minute consultation? All of this leaves me unable to shake the sense of foreboding during my mental health consultations.

Whilst I understand rationing is necessary, it seems that a certain group of patients are paying the biggest price and the disproportionate dissolution of this service only serves to further stigmatise an already highly vulnerable section of our community. It is certainly clear that the mental health service is a victim of austerity cuts, the consequences of which are ultimately paid for by our patients and their families.

With the awareness of mental health being raised with such vigour, we need the same energy to push the government to fund a specialty that has been rendered insignificant. All parties in this election are promising more money for the service. I sincerely hope they fulfill their pledges and that it is used to reopen services rather than employ people to further reorganise the system or audit easily manipulated waiting time targets. Time will tell, but one thing I do know for certain is that the human cost of the lack of mental health services is unacceptable and must not be allowed to continue.

I would like to dedicate this article to my favourite artist, friends, family and patients who felt life was too dark to go on.

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