Medication prescribed by GPs for emotional difficulties is increasing at what is, perhaps, an alarming rate. One in three GP appointments has a mental health component to it and the reported rate of psychological need has increased as a result of the covid-19 pandemic and associated restrictions. With statistics such as these now well known, I think it’s time that psychological professionals focus their attention upon general practice and community settings. Your local GP, close by, familiar, lacking the stigma and sometimes complex access associated with mental health services seems an ideal place to start. With the average GP offering 10-minute appointments, and many GPs saying they don’t feel appropriately skilled to work with mental health and it’s varying presentations, it’s perhaps not surprising that ‘watchful waiting’ or a medication prescription are two overused tools.
General practice settings seem to be the ideal place to provide early support, such as, psychological professionals delivering mental health prevention and promotion work. Being able to intervene early, at the point when a distressed individual first raises their concerns and tells their GP that they are struggling, feeling stressed or worried is surely the right thing to do. Without the emotional literacy to understand that their racing heart is a symptom of anxiety (for example), or understand how their lack of self-care, poor sleep, avoidance of social meet-ups and embarrassment about sharing their struggles with friends will impact upon their emotional wellbeing, how can we expect someone to be able to look after their health? As a result of the investment in National approaches such as the ‘Eat 5 a day’ and ‘Change4Life’ campaigns, our awareness about how to look after our physical health is improving. With the desired move towards achieving ‘parity of esteem’ between physical and mental health care services, it’s now very timely for more emphasis to be placed upon mental health promotion and prevention in primary care services.
I’ve been in the very fortunate position of being part of a Health Education England funded evaluation exploring exactly this very topic. Is it feasible to provide such a service in general practice settings? How possible is it to link with community services and how can this be done?
In September 2020, we trained four psychology graduates, employed as Assistant Psychologists, for the period of one month in all we felt they needed to know to start offering brief interventions focusing upon mental health prevention and promotion. Their knowledge would be continually added to through weekly individual and group supervision and an ongoing timetabled CPD. They were then deployed into two practices in Lancashire, each location had unique population needs and assets. The graduates settled quickly into their two teams and were made to feel welcome. Although there was some additional work to do at the start in relation to getting appropriate referrals (people whose needs could be met within the context of a brief intervention focusing upon prevention and promotion approaches), the service established itself quickly. The clinicians focus upon providing clinical work 4 days a week and then on supporting the local community to increase resiliency on the fifth day of the week.
9 months in and due to complete at the end of July 2021, we are now beginning to write up our evaluations and project closure report. So far, all is looking very positive. Statistical analysis of the 6 months dataset shows statistically significant improvements across all four psychometrics used between the first session (1) and final session (4). The improvements have also been maintained at follow-up, 4-6 weeks later. Qualitative information is collated via an experience of service questionnaire for the client and ‘an-important-other’ (whomever they chose to bring along), interviews with the workforce, GP’s, other general practice staff (including nurses and practice managers) and community leaders is overwhelmingly positive. In the next step, we are expanding this approach across more settings and will review how it is received and the impact it has.
If you’d like to hear more about this, join the 'Deploying Psychology graduates to primary care and community settings to provide a mental health prevention and promotion service: Results of a feasibility study' webinar on the 22nd July 2021,11:30am - 12:30pm: https://www.nwppn.nhs.uk/events/icalrepeat.detail/2021/07/22/451/-/webinar-deploying-psychology-graduates-to-primary-care-and-community-settings-to-provide-a-mental-health-prevention-and-promotion-service-results-of-a