Does NHS “General” Practice support adequate assessment and treatment of mental and behavioural problems?
I have never met anyone working within the NHS who believed that more than a minority of UK general practitioners have a great interest in mental health issues. As a trained and qualified GP myself, I have much affection and regard for my non-specialist colleagues. But unfortunately because their views are often so much in line with mainstream opinion (hence those persistently high “public trust” ratings?), that can sometimes include a dismissive approach to human frailties.
A confidential survey of GP’s, published last week by the leading mental health charity Rethink, appears to have confirmed this (1). The new government wants general practitioners to decide on funding priorities for specialist services, and over three quarters are happy to do this for physical conditions, but less than a third want to be involved in mental health.
This is despite GP’s having a very negative view of existing specialist mental health services. When asked “To what extent would you feel confident in the quality of care one of your relatives would receive if they were referred to the appropriate NHS services” only 50% said they would feel confident for depression (as against 92 – 95% for physical conditions). For obsessive-compulsive disorder (OCD) the figure was 32% and for post-traumatic stress disorder it was a miserable 22%.
I don’t blame GP’s for not wanting to take on the re-funding of NHS mental health services. To do so in the current financial climate would probably mean advocating cuts to clinical services for physical conditions, which would be deeply unpopular. Privately, many of them support their better-off patients seeing independent non-NHS specialists, which in itself at least expresses a degree of discontent with the current situation.
But keeping this issue at arms length might lead patient groups to further question the ordinary good sense, even the fairness, of general practitioners. Rethink continues to highlight a previous survey as showing that “23% of people with mental illness report experiencing discriminatory treatment from GPs” (2). It could be a good time for the minority of GP’s with a special interest in mental health issues to become a majority.
(2)http://www.mentalhealthshop.org/products/rethink_publications/stigma_shout_survey.html# Quotation from (1). In this 2008 survey psychiatrists did not do much better, which I would interpret as further evidence for the inadequacy of NHS services.
“Autism is a serious, lifelong and disabling condition” (1) according to the chief executive of the National Autistic Society (NAS), which continues its excellent work in raising awareness about developmental disorders. But I wonder sometimes if this all-or-nothing headline message might discourage people from seeking treatment, when they see themselves as having milder problems.
The idea that autism is a spectrum not just of how it presents, but also of how severe it is, shading into normality in both respects, has been around for a while now. I have recommended Simon Baron-Cohen’s book The Essential Difference to several patients, because I thought it might be helpful to see how one leading researcher into autism views this issue.
It is likely that there are many people who are functioning, perhaps working, but not really doing very well, who probably have mild autistic spectrum disorders. Traditionally, psychiatry has assumed that “perfectionism” or “rigidity” are fixed and untreatable personality traits. This has been challenged by many studies now, and this week a report from researchers in Lyon, France (2) adds to the evidence that medications can improve the core features of autism.
Treatments (or “interventions”) in severe or moderate developmental disorders do not usually cure in the sense of moving the features of the condition into the spectrum of “normality”. A change from severe to moderate, or moderate to mild, would be considered a good response. But by starting off with a mild disorder, and moving towards normal functioning, whatever that is, you might have good reason to think that you had been cured of your disability.
(1) The Times, February 6th, page 29. Also at: http://www.timesonline.co.uk/tol/life_and_style/health/article7017168.ece
(2) Andaria et al (2010), early epublication of abstract at: http://www.pnas.org/content/early/2010/02/05/0910249107.abstract
I will talk about non-medication-based approaches for autistic spectrum disorders in a future posting(s).