Data obtained by the mental health charity shows that in England, on average, less than half (46 per cent)[i] of trainee GPs undertook a training placement in a mental health setting. Furthermore, the only mental health-related option offered to trainee GPs was in psychiatry, which is based in hospitals and secondary care-focussed. Once qualified, GPs are required to undertake ongoing training in order to continue to practice, but, at the moment, none of the hours they spend on Continued Professional Development (CPD) need to have a mental health component. This is despite an estimated one in three GP appointments being related to mental health[ii].
Practice nurses are being let down too. More than four in five (82 per cent)[iii] practice nurses said they feel ill-equipped to deal with aspects of mental health for which they’re responsible. More than two in five (42 per cent)[iv] said they’d had no mental health training at all.
The vast majority of people with mental health problems who do get treatment are seen within primary care – 81 per cent of people first come into contact with mental health services via their GP, with 90 per cent of people receiving treatment and care for their mental health problem solely in primary care settings[v]. Given how big a role primary care staff play for people with mental health problems, Mind’s report ‘Better equipped, better care: Improving mental health training for GPs and practice nurses’ calls on the Government to ensure all GPs and practice nurses receive structured mental health training that is comprehensive, relevant and supports their ongoing development.
Paul Farmer, Chief Executive of Mind said:
“For most of us, our local GP practice is the first place we go when we’re unwell – whether it’s related to our physical or mental health. GPs and practice nurses have an incredibly difficult job to do, under enormous pressure and demands.
“A significant number of patients they come into contact with will have experienced mental health problems, yet many primary care staff tell us they haven’t had sufficient training to be able to deal with them. That’s why we’re urging the Government to ensure structured training is in place for trainee and qualified GPs and practice nurses.
“Providing structured mental health training to primary care staff would help ensure they have the knowledge and confidence to provide quality mental health support to the many patients coming through their doors who are struggling with their mental health. Offering more training would help patients get the best outcomes while also alleviating some of the pressure GPs and practice nurses experience on a daily basis.”
Kathryn Yates, Royal College of Nursing (RCN) Professional Lead for Primary and Community Care said:
“Mental health problems account for a huge amount of the demand on primary and community services, but this is simply not reflected in the training available. All health and social care staff should view mental health as an essential part of their job, from encouraging people to speak up and seek support or treatment, to supporting families and keeping people as well as possible at home.
“More training for primary care staff would not only help people to manage their mental health and wellbeing better, but could also ease pressure on other parts of the health service. A person with a mental health problem must be able to expect that any staff member they talk to or seek support or treatment from should be fully trained and confident in helping them.”
Felicity, 27, is studying for a mental health nursing degree in Plymouth.
“Having a supportive GP who understood mental illness made all the difference. I initially went about my ear infection, but because he asked how other things were, I ended up breaking down in tears and explaining that I wasn’t in a good place mentally either. He talked me through options, such as talking therapy and antidepressants, and arranged a follow up appointment.
“When I went back to the GP after a fortnight, I decided to take citalopram and he signed me off work for a further week. I ended up leaving my job and moving down to Devon to be near my family. I now have a new partner, and I’m working towards my dream job of becoming a mental health nurse. A lot of what has happened was down to my GP, who was so much better than I ever could have hoped. I know not all patients are as fortunate which is why I support Mind’s call to improve mental health training for GPs and practice nurses.”
Charlotte*, 28, from London, has mixed depression and anxiety disorder, and undiagnosed Post Traumatic Stress Disorder (PTSD), as a result of childhood sexual abuse. She says:
“Like lots of people my age, I’ve moved around a lot, rarely seeing the same GP twice. The best experience I had was a GP who was sympathetic, but referred me on to services that never materialised. But the majority of GPs haven’t properly understood me when I’ve tried to tell them how I’m feeling. As a result, it’s taking me many years to get the right diagnoses, help and support. Often I’m told they can’t do anything and turned away. If mental health problems are spotted sooner, they’re a lot easier to treat.”
Dr James Booth, 38, is a partner in a GP practice in Chelmsford, Essex. He said:
“A huge number of the patients who come through my door are struggling with mental health problems. Through my own personal and professional experience, I now feel well equipped to support someone struggling with their mental health. As a trainee GP, I didn’t do any placements in a mental health setting. Turning down the opportunity to get some experience in psychiatry is one of my biggest regrets.
“The long hours and heavy workload that comes with being a GP and a practice partner aren’t always conducive to good mental health, so it’s really important I look after my own wellbeing to ensure I’m providing the best service for my patients. More structured mental health training would help GPs and practice nurses to identify signs of poor mental health – whether that’s their own, their patients or colleagues, which is one reason why I’m joining Mind in calling for this.”
Dr Emma Nash, 38, is a GP practice partner in Portchester, Hampshire. She has been a qualified doctor for 14 years, 6 of which as a practicing GP. She is the Clinical Commissioning Group (CCG) lead for mental health and has written and developed GP training on suicide prevention and mental health in children and young people. She struggled with post-natal depression after the birth of her first child in 2005.
“Because my patients know I have a special interest and expertise in mental health, roughly half of those I see have mental health problems. As a trainee GP, I didn’t do a rotation in psychiatry. I developed a particular interest in mental health during my time as a GP registrar, so once I’d completed my GP training I went back to the beginning and joined a psychiatry training rotation, working solely in psychiatry for 18 months. It was hugely valuable.
“I think there is a huge role to play for community mental health placements for GPs. Inpatient work is largely service provision rather than educational. However, it is useful to see the severe end of the spectrum. In an ideal world, if it was solely about education, all GP trainees would spend some time with the crisis team (or home treatment team), the community mental health team, and Improving Access to Psychological Therapies (IAPT) services.”
Mind is urging people to sign a petition calling on Secretary of State for Health Jeremy Hunt, to improve mental health training for trainee GPs and practice nurses.