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CAMHS won't see you now

There are times when 'stop watching TV and go for a walk' is the right advice

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It takes, on average, about 10 seconds for a certain type of patient to come in blurt, ‘I don’t know where to start…’ and dissolve into tears. I pass the tissues, wait and listen.

Depending on whom you listen to GPs are not diagnosing mental health problems well enough, or overdiagnosing them and prescribing too many psychoactive medications. How is it is possible for both of these apparently opposite paradigms to co-exist?

At a recent conference, a patient asked  health minister Norman Lamb when health professionals would start taking mental problems seriously, after being told ‘to stop watching TV and go for a walk’.

Lamb replied: ‘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.’

As a GP who regularly diagnoses and intervenes to treat mental illness, I feel I am damned if I do, and damned if I don’t. It’s made all the more difficult due to the pressure of trying to assess someone’s mental health in a single appointment, especially if there is a waiting room full of people, some of them with similarly time-consuming problems.

The consequences of getting it wrong can be disastrous. Not picking up the early, perhaps non-specific signs, of mental illness that later lead to suicide attempts, hospitalisation and perhaps even deaths, has massive effects on the patient, their family and the practice. As with any missed or delayed diagnosis it can be difficult to handle for the doctor.

What I find most difficult, though, is the other end of the spectrum – the milder shorter-lived symptoms, usually in patients that have been labelled as ‘depressive’ or ‘anxious’ in the past. Patients who may well have been off and on antidepressants all their lives. Patients who have had a difficult childhood, unsatisfying and unpleasant work situations or who are simply very unhappy about where they live due to the quality of either the housing and/or the neighbours. These already difficult situations can be made worse by an acute crisis such as a relationship breakdown, bereavement, unemployment or financial hardship.

There are a group of patients who fervently don’t want to be medicalised and be ‘on tablets’. There are others, who after describing how they feel, say that they couldn’t possibly talk to a stranger about how they are feeling.

I have found myself saying to patients, ‘I would feel unhappy if I was going through what you are going through. But, what we have to decide here is whether your unhappiness is truly depression, or whether it is a natural reaction to the circumstances that you are going through.’

As I have written before on this blog, I have often explained to those wanting ‘something to make me feel better’, that a GP can’t change your job, your housing, your family, or your relationships.

And when they get better, as they usually do, I have no idea if it is the change in neurotransmitter levels, the natural passage of time or the fact that they simply had the chance to offload on me.  Perhaps NHS-grade tissues have got powerful properties.

Dr Samir Dawlatly is a former secretary of the RCGP’s adolescent health group and a GP in Birmingham.

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Readers' comments (10)

  • diificult when NICE guidelines do not recommend SSRIs for mild or moderate depression.
    Perhaps it is just the time and off loading that is important.

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  • "Not picking up the early, perhaps non-specific signs, of mental illness... has massive effects..."


    Presumably "early, non-specific signs" in any given patient are fairly likely to go away if untreated.

    Is there any evidence at a population level that treating these non-specific signs improves outcomes, compared to treating any definite, specific signs of mental illness that may develop later?

    If not, it doesn't seem worth agonising over.

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  • In my experience most patients with 'non specific symptoms' just want you to wave a magic wand and fix their generally crap life, then when you explain you can't they get upset and complain, or just keep regurgitating the same information (just in case you change your mind and can actually fix it) until you usher them out of the room.

    Also it's hardly a surprise most depression gets treated with antidepressants (despite NICE guidelines) is because when patients are feeling very low and depressed, they generally don't want to wait for 3 months to see the IAPT team, and then have to wait even longer to get any help from it so invariably choose th option of antidepressants instead.

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  • Hmmm, I've just been looking through the 8K odd GP's payments received from the NHS & some of you must be doing something wrong. Loads of GP practices seem to be paid vast amounts of money to diagnose lifetime drugs, statins, blood pressure, stress medication etc. Perhaps, the A&E & GP NICE guidelines are mutually exclusive. I'm loosely connected to the GP situation & you all have my heartfelt thanks & utmost sympathy. Political control has to be removed & I don't know how; you are all going to be used like a pinball machine, at least, until after this Election.

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  • GPs are not not all interested in psychological/social issues for others it is what keeps them in practice.....knowing what is available in the community and who else to refer on to, often in the same practice, is at least worth a try when people haeve confided that life is so the way it takes very little effort to run off a letter somebody can take to a housing office and there is shamefully a payment which can be requested. How much help has the average GP received in order to arrive in a position whereby they can enjoy the good life - and so much influence over another's crap life? No time is no excuse for sending someone on the road to drug dependancy/rotten housing/unemployment/ stigmatisation

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  • 10:49

    There speaks a non-GP who has no concept of what it is like be one. No time is definitely an excuse that is true.

    What else could YOU fit into those elastic ten minutes ?

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  • Trolls are taking over Pulse. Can't we have a clearout and just give logins to people who can justify being here?

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  • 1049 could try applying for a gp post, he /she/it claims to know all the answers.i agree these trolls should be removed, they have the daily hate mail to vent their spleens

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  • This comment has been removed by the moderator.

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  • Sorry got the wrong anonymous.Above comment aimed at Anonymous | 15 February 2015 10:49am

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