It’s the first time I’ve met her. I can see when she comes in that she is utterly miserable. She looks exhausted as well. She sits down and with a sigh says that she doesn’t really know why she’s here, that she knows there isn’t really anything that I can do.
I hear her story. She’s got three children – two of which have never had any problems, but she’s frantically worried about the youngest, the seven year-old. She tells me how his behaviour is getting worse and worse – he can’t concentrate on anything, is utterly disruptive at home and at school, and is starting to get aggressive. He doesn’t seem to be able to play with other children, and doesn’t understand their reactions. She tells me that he seems so frustrated when he doesn’t get his own way and sometimes doesn’t seem in control of his actions, and is very sorry afterwards for the upset that he causes. She’s getting increasing numbers of calls from the school talking about how difficult he is to manage.
He was referred by another GP not long ago and was seen at the child development centre by the community paediatricians, who said they were wondering about ADHD, and possibly an element of autistic spectrum disorder. They did a referral to the relevant team for support, and she has heard from them saying they will see her as soon as possible but the waiting list is months and months due to ‘staff shortages’.
Another woman has been seeing me about her anxiety. It mainly circles around her health, and she’s had huge numbers of tests over the last five years, which have all been absolutely fine. There are lots of issues about her childhood and her parents that we discuss regularly – she’s really struggling, and her feelings are starting to change into anxiety about her young daughter’s health as well. She’s just starting to come around to the idea that her worries are psychological in origin and is desperate for counselling. The wait for this is three months. She has started seeing a private therapist, which I’m so pleased to hear is actually going very well, but she’s finding it really hard to afford it.
The reason I’m writing about these two patients is that they’re representative of so many people I see in general practice. They have a clear need for help from mental health services but the waiting lists are massively long. While they are waiting, their problems are getting worse and they are really struggling. I’ve written to expedite their appointments, I talk to them regularly and suggest what I can, and point them in the direction of other sorts of support as much as possible, but the fact is they are waiting an unacceptably long time for help. Children’s mental health services in particular I have noticed are so short staffed – and I have heard that this is not just a problem where I work.
If these patients were dealing with physical health problems that were getting worse due to a lack of care, I don’t think the wait would be tolerated – and there shouldn’t be a difference. Mental health problems are just as worthy of investment and treatment as physical ones, and such a tremendous difference can be made to people’s lives with the right help. The patients that have received help from the local mental health service are generally hugely positive about their experiences and are so glad that they sought help.
The more time I spend in general practice, the more I see that a huge amount of what patients need from health services is not purely physical – there are such a vast number of people struggling with psychological and social problems and sometimes it feels that their GP is one of the few sources of support. I am increasingly seeing that there is a huge difference between the priority given to physical health problems and mental health problems – and the disparity is unaccountable to me.
Dr Georgia Belam is a GP in Devon
