As a GP, many of my patients struggle with the concept of mental health. It often brings up feelings of guilt, failure or embarrassment, but I don’t see the same when discussing a physical condition, such as an eye infection, a knee injury or a heart attack. Stigmatising attitudes towards mental health are imposed by society and also by patients themselves. So let’s try to break down the stigma, and bring conditions of the body and the mind to an even playing field.
I think there are quite a few similarities. Let’s go through a couple of scenarios, starting with someone who has knee pain. Urgent: The GP is concerned there might be a bone fracture, so they advise them to go to hospital to get the urgent help needed. The X-ray shows no fracture, the GP and patient are reassured, and the patient is told to treat it as a muscle, ligament or tendon injury. Recovery: The patient is given advice on rest, ice, compression, elevation and subsequently physiotherapy exercises to do to aid recovery. Negative recovery outcome: The knee isn’t what it used to be, and affecting the patient’s life. The patient could seek further advice and information from their GP, who may arrange more scans or referral to a musculoskeletal specialist. Positive recovery outcome: The patient is happy that the knee has recovered. They can continue to be conscious of the knee injury history, being careful when exercising, they continue good practice with maintenance exercises and they manage the problem themselves.
I think as GP's, we approach things in a similar process, but we use different tools for mental health. If we take the example of someone who is depressed and feeling suicidal. Urgent: If the GP is concerned the person is suicidal, hospital is a place of safety for all mental health crises. There are other urgent access services called Crisis Teams in local areas, which are staffed by mental health experts and are accessible 24/7 via telephone. The crisis will be assessed and if the patient is deemed safe for discharge, the patient will receive advice and a plan made for follow up. Recovery: There may be regular check-ins at the patient’s home, or talking therapy arranged, or a plan to see their GP arranged to discuss ways to aid recovery. Negative recovery outcome: If the mental health crisis doesn’t feel like it’s improving, there are other options to hand. Alongside different talking therapies, medications, specialist psychiatric teams, there are also more intensive supports such as crisis houses and inpatient hospitals where people can receive further treatment and follow up. Positive recovery outcome: The depression symptoms are improving. We can continue to be conscious of the mental health history, being careful to safeguard difficult life situations that could trigger worsening mental health. And also being aware of the early symptoms of things getting more difficult.
Whether you are suffering and it’s difficult to recognise or admit, or whether you see a friend, colleague or family member struggling, it’s best to address things. Kindness is key and goes a long way – if you treat everyone with the dignity and respect you would appreciate, you can’t go too wrong. But kindness also extends towards yourself if you have depression or another mental illness. Try talking with friends and family about mental illness, it normalises the topic and allows people more space to share their own personal experiences. Reach out to health services and NHS support groups. It always surprises me how popular group therapy is – patients don’t think they’ll like it, as they’ll feel exposed and vulnerable, they think they’re the only one feeling that way – but they get a real boost out of helping others. And it brings more understanding of their own condition.
If you are having concerns about mental health issues, or are having symptoms that are affecting your day-to-day life, you can turn to your GP. You could arrange a routine appointment to discuss confidentially with your GP, whether you are a child or an adult. They also usually have the means for urgent access, if you feel you are in a crisis. There are also support groups that can be a great resource for people struggling with specific problems such as substance abuse. * Written by Dr Tom Bracewell, Caidr's Chief Medical Officer and practising GP