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Some GPs 'totally get' mental health. But I'm not one of them

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This week, GPs are mostly rubbish at mental health.

That seems to be a fairly broad brush criticism, but it came from an exchange between Norman Lamb, health and care minister, and a ‘service user’ at a conference on psychological therapies, so it must be true.

For the sake of balance, I should add that, while Mr Lamb did say that some GPs ‘come out with rubbish’, he also said that some ‘totally get it’.

Well I, for one, don’t. For example, I don’t totally get how he could take at face value the assertion during a Q&A session that GPs don’t take mental problems seriously - the evidence for this being that the aforementioned service user had supposedly been told by a health professional to, ‘Stop watching TV and go for a walk’.

I don’t totally get how he might not try to step back and contextualise that comment by appreciating that a) It was unlikely to have been the sum total of the help given and b) As part of a package of care for - and I’m guessing here - ‘depression’, it’s reasonable advice, given that watching TV during the day would depress anyone, and exercise can be very beneficial, particularly if you’re walking away from the Jeremy Kyle show.

I don’t totally get how he can extrapolate from that to the conclusion that ‘there’s an enormous way to go’ regarding our ‘attitudes towards mental health’, as if we GPs loathe those with ‘bipolar’ or ‘feeling a bit OCD’ any more than the average punter spouting inaccurate, self diagnosed, overblown nonsense.

And I don’t totally get how he doesn’t totally get the irony that, when we’re not being criticised for giving well-meaning/evidence-based lifestyle advice to people with ‘mental problems’ we’re being criticised for prescribing antidepressants unnecessarily, presumably when that lifestyle advice is perceived by the ‘service user’ as not taking the problem seriously enough.

Yes, of course, we’d love to administer some of that de-rigeur talking therapy, but it was around the time I worked out what IAPT stood for that the access to those therapies seemed to vanish.

So: lifestyle advice is rubbish, antidepressants are drugs of Satan, and the queue for CBT starts somewhere over the horizon.

In other words, we GPs are stuck between a rock and a hard place and a rock.

So no, Mr Lamb, I totally don’t get it at all, really. But then, I’m not sure you do, either.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield.

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Readers' comments (14)

  • Maybe Copperfield should step back and contextualise Mr Lamb's comment. Perhaps the service user isn't the only person that Mr Lamb has spoken to. Perhaps the service user's comment wasn't the sum total of evidence that Mr Lamb engaged with before making his comment.

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  • Anonymous | 12 February 2015 2:08pm

    Well this was typed in the article -

    Mr Lamb was responding to a question during a session on ‘the mental health gap’ from a service user who asked when would all health professionals start taking mental problems seriously, after being told ‘to stop watching TV and go for a walk’.

    Mr Lamb said: ‘Well I totally accept the central point that there is an enormous way to go still. And one of the things that is essential is attitudes of clinicians towards mental health…I happen to believe every GP needs to be centrally trained in mental health and we’re not there yet.

    ‘Attitudes in primary care are very variable, you get some great GPs who really get it and others who just come out with the rubbish you just described there.’

    1. If you know any more, then please enlighten us
    2. If you don't understand satire, then stop reading Copperfield

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  • Spot on as ever

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  • @2:08
    This is the problem with this society. A lot of people think they can do doctors' jobs without going through the rigors of training. It seems easy yet.
    As clinicians, we are trained to think scientifically and respond to evidence.
    Copperfield's piece is based on evidence in the report.
    Anonymous 2:08pm would rather comment on his own assumptions and imaginations.

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  • Anonymous 12 Feb 5:18pm

    This is the problem with GPs. A lot of doctors think they know everything because they have gone through rigorous training.

    Perhaps, because they are trained to think scientifically, many might be less inclined to understand emotionally and empathically.

    Perhaps Anonymous 5:18 would rather comment on his own assumptions of the self-back-patting that many professionals' silos seem to get stuck in, including nursing.

    From a personal experience I took my younger son, aged 25 at the time, to our one of our new GPs after we had moved to another area. Our previous GP had tried to move heaven and Earth to get my locality council to have him assessed for Aspergers. This new GP listened to his difference in behaviours I had noticed from his being 2 wks old, and that I had struggled with him for 25 years being "different". She looked at him, and because of his bland expression and dull responses, she deduced in less than 5 minutes that he had depression. She also followed by telling me, "he needs to get a life". I came out of her consulting room in absolute despair and felt no where else to turn. She even gave him a PHQ-9 form and sent me outside. (It took me a further 6 years to get his diagnosis)

    My oldest son was estranged from me due to wat appears to be a sleep disorder (from childhood) and he had sunk into depression. His work tried to offer support but had told him he needed to see his GP. (He kept sleeping through till evening and misses whole days-no alcohol).

    First GP told him to join a gym and get more exercise, to get more tired so he could sleep earlier. He didn't bother to find out this son was already doing this. In desperation, about to lose his job, he returned to GP, a different one. This one read what the previous GP did and said the same thing. At this point this son spoke with me and asked him to be more assertive with GP and consider referring to sleep clinic (though I was no optimistic they only dealt with COPD issues). This 3rd GP did do a referral but the test was scrapped when said son could not sleep to be tested!

    3 GP's within one practice did nothing proactively to help my son and he lost his job. People with depression are not very good at expressing their needs and are easily fobbed off, especially young men. They are extremely vulnerable. I am still supporting this son, but a GP in Sheffield is now supporting and monitoring his depression.

    Professionally, I was told in 70's, as a student psychiatric nurse (I left before I completed), by a tutor, that we would cover more mental health in our 6 week introductory course than a GP would cover in 5 years. Ok, that might not be accurate then or now, but as a practice nurse I do see patients frequently being commenced on anti-depressants before anyone has discussed with them their choices. I see patients who have been on them 10 years or more with no further assessment, and I see patients not being treated as individuals and being assessed for which TYPE of depression they might have. I see many patients who do not know what depression is and have been commenced on anti-depressants because "I feel a bit sad" and not in the "black dog" foggy land that true depression results in.

    Yes, there are many understanding and educated GPs aware of depression, but there are far too many, often perhaps without sufficient time, to really understand the needs of the person in front of them and this can be extremely destructive. It is not a scientific issue.

    I think it would be more cost effective and better for patients for there to be a mental health specialist attached to each practice. It could be a GP, counsellor, practice nurse. They do not have to be medically trained, but have additional skills and an interest, especially empathy in those struggling with this dreadful illness.

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  • General Practice is difficult because there are so many specialisms , but few specialists; so we are left dealing with a lot of stuff that may not be something we are good at. I know medicine well, I worked in it. Mental health, I confess I do not know very well. But I cannot possibly know everything very well.

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  • Given that significant mental health problems are present in at least a quarter of GP patients (not 'service users'!) and that most GPs don't undertake formal psychiatry placements during their training and very few access postgraduate training in paediatric mental health issues (even on such prevalent neurodevelopmental disorders as autism and ADHD which are still sometimes ignorantly written off as being the result of 'bad parenting') Copperfield's attitude and views are depressingly common. Evenmore worrying is that GPs are now expected to commission effective mental health services for all of their patients. This disconnect between understanding and reality is a recipe for disaster and needs to be rectified quickly.

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  • i did 6 month sof psychiatry and i dont thing that my colleages fail to take mental health seriously . as mentioed we see lots of it so why doing GP itself isnt good training for the type of things we see I dont know. wee see a lot of people who feel down in the dumps due to life stressors poor childhoods and lack of drive/ability/knowledge how to make their lives better and not true mental health problems. so advising them to get out more do something useful like exercise of voluntary work is perfectly apropriate

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  • Dear Anons,
    I'm a GP, paid an obscene amount of money and am completely useless at everything but I don't waste my abundant spare time reading satirical columns intended for other professions.

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  • An entertaining piece, and I especially agree with

    "it’s reasonable advice, given that watching TV during the day would depress anyone, and exercise can be very beneficial"

    But... prior to my current role I've also worked as a mental health support worker (primarily around schizophrenia), and accompanied my 'service users' to GP appointments. The GP wasn't in the slightest interested or engaged with them, and quite clearly saw the MH patients on his list as a burden.

    There are many absolutely wonderful GPs out there (including my own), but there's also a minority that appear to be unable/unwilling to engage with MH issues.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder