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'We should not go back to a mental health worker in each practice', says NHS chief

GPs may soon be able to access more locally based mental health services for their patients, but should not be reliant on having mental health workers based in practices, following comments from the national lead on mental health in England.

Dr Geraldine Strathdee, NHS England’s national clinical director for mental health, called for more access to local mental health services ahead of the launch next Monday of NHS England’s long-awaited independent Mental Health Taskforce report

They also follow calls from RCGP chair Professor Maureen Baker to have ‘mental health workers based in practices for real time referrals and support’, under a series of ‘emergency’ measures the College is working on with NHS England chief Simon Stevens.

Speaking at a Westminster Health Forum event on priorities in mental health services, Dr Strathdee said: ‘I must admit I get slightly depressed when I hear people say we’re going to have a “mental health worker” in primary care, because what we don’t want to do is go back to non-evidenced interventions.’

Dr Strathdee added that this risked going back to historical situations where ‘you have your own community psychiatric nurse in primary care who has a caseload of 100’, which she said would mean ‘you cannot give the psychological interventions, or the case management people need’.

Dr Strathdee told Pulse each area should instead offer services according to their local population’s needs – so that, for example, GPs with high numbers of patients with psychosis should have access to community ‘enhanced psychosis’ doing outreach work.

She said such models typically involved ‘having one half day a week of a GP with a special interest in psychosis, and a practice nurse who is dedicated to helping people and working in collaboration with peer support workers, family and the third sector to go people’s homes help them socialise, help them have a healthy lifestyle and get to their appointments’.

Dr Strathdee said there were a range of models that could be offered, including group therapy done in practice clinics, to boost the offer of psychological treatments for people with long-term conditions and comorbid depression or anxiety – which is expected to form a key plank of the Mental Health Taskforce report.

She said: ‘In many places in England they are doing this in quite a smart way and looking at where would be most helpful to do things in groups – for example I’ve been to places where there are 16 people in a “Living well after stroke group”, integrating physiotherapy and psychological therapy in a large GP health centre.’

Readers' comments (6)

  • Oh dear. We are part of a bid to run our local primary care mental health services and have proposed exactly this. Will be on the NHS England naughty step

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  • Why would they make primary mental health workers available in every GP practice? If they are not there, it will just fall on to the shoulders of GPs as part of their core funding - therefore saving the government loads of money!
    #Cheap=Best

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  • It's wrong policy, gp are trained to be generalist not specialist in mental health.

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  • Having attached counsellors/ CPNs/clinical psychologists REVOLUTIONISED mental health care in our practice.
    It would be a backward step if we lost them again!

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  • Omg
    Depression, anxiety, non specific mental health problems are a large part of primary care consultations and because there are few real measureable endpoints (phq9 a joke in sheeps clothing bought in by qof) the very anal who desire these details suggest we remove support because our measuring tools are inadequate - wake up and try and engage in reality Mr /Mrs bean counter - if you are unable to count your beans to justify current interventions then find new measures instead if leaving those in need without support because of your inadequacies. Mental health is equally as disabling as any physical health so don't dismiss it because you can't easily measure it! We've only just started to understand/measure gravitational waves- doesn't mean they didn't exist before only that we couldn't measure/detect them.

    The village idiot who seems to hold sway in these decisions amazes me
    .

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  • In the good old days of GP Fundholding, we had our own CPN,and even timely access to a psychologist.A brilliant service, not least because you could just knock on the CPN's door and discuss a case with her.True integrated care; let us have more of it.
    Having said that, if the bath is overflowing, we need to turn off the tap not design a better plug hole.We must stop medicalising unhappiness, and more importantly the public must realise that having a tiff with their boy/girl friend does not constitute a "mental health problem" nor justify a sick note and 6 months on an SSRI.Only in this way can we free up the time and resources to concentrate on the potentially devastating illnesses that are endogenous depression and psychoses.

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