Jonathan Coates is a GP at St. Anthony’s Health Centre in Newcastle, and a Clinical Fellow at the Institute of Medial Humanities at Durham University.
Nick Hartley is a Clinical Psychologist at St. Anthony’s Health Centre in Newcastle, and has experience across primary care and health psychology settings.
Are GP practices equipped to respond to the current mental health crisis?1–3 Long waiting lists for services and patchy community-level interventions leave GPs trying to treat psychological, social, and economic distress with their prescription pad: as Maslow said, ‘I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail’.4
Our pilot of the role of GP clinical psychologist (GPCP) draws on previous work in Burnley,5 in an attempt to broaden this repertoire. In contrast to other mental health roles in primary care, the GPCP is an experienced, senior clinician, independently handling undifferentiated presentations in all ages and managing risk. This seniority is reflected in how the GPCP works: they are not seeing patients who the GP has already assessed, they see patients first, instead of the GP. Like GPs, they see patients in one-off appointments, rather than extended courses of therapy.
A formal evaluation of the role was recently published.6 Here we offer some personal reflections from a GP and GPCP perspective.
Personal reflection — Jonathan Coates
First, patients now have access to psychological expertise, with no barriers. Many of my patients can’t get through the front door of mental health services: they’re ‘too chaotic’, ‘too risky’, or they use too many drugs. Just like a GP, the GPCP will see anybody and everybody.
“… I see this as a small push against the creeping medicalisation of distress.”
Second, I see this as a small push against the creeping medicalisation of distress. Patients and doctors can both fall into a narrow, medicalised view of distress, which I believe has significant and underestimated harms. Having a psychologist’s expertise in the team, working directly with patients, and having lunchtime team discussions serves to broaden the view of both patients and clinicians.
Finally, there has been a positive impact on GP workload and job satisfaction: the GPCP is able to deal with complex presentations that would otherwise have been seen by a GP.
Personal reflection — Nick Hartley
Mental health does not exist in a vacuum. Unless we get a better understanding of the socioeconomic conditions that our patients experience, we won’t find sustainable and effective responses to their distress.
Being based in a GP practice expands my horizon as a clinician working not just with the patient in the room, but starting to see the connections that patients have with each other and with local organisations that often run on goodwill.
“[It’s] given me an insight into the pressures GPs are under … “
It’s also given me an insight into the pressures GPs are under, and the impact this has on many people who come to the GP for social needs as well as medical concerns. Opening up access to psychology is humbling and daunting as it forces me to examine how our practice can be applied in brief, single-opportunity consultations. It makes us look outwards at how we can work more systemically to improve living conditions.
We know that deprived communities suffer a higher burden of mental health problems than the general population,7 while access to psychological therapy follows the inverse care law: patients from deprived communities are more likely to be referred, but less likely to access therapy.8
Against this backdrop, we are pleased to have the support of our local Deep End Network as we broaden the service to a neighbouring GP practice as well as recruit additional mental health practitioners with different skillsets. We believe that embedding psychological expertise in GP teams is a step towards more equitable and effective mental health provision.
1. Campbell D. Extent of mental health crisis in England at ‘terrifying’ level. The Guardian 2021; 9 Apr: https://www.theguardian.com/uk-news/2021/apr/09/extent-of-mental-health-crisis-in-england-at-terrifying-level (accessed 28 Feb 2023).
2. Davies J. Sedated: How Modern Capitalism Created Our Mental Health Crisis. London: Atlantic Books, 2021.
3. Brossard B, Chandler A. Explaining Mental Illness: Sociological Perspectives. Bristol: Bristol University Press, 2022.
4. Maslow AH. The Psychology of Science: A Reconnaissance. South Bend: Henry Regnery, 1966.
5. Fisk L, Tobin V. Changing the emphasis of how we work as clinical psychologists: learning points from a GP pilot project. Clinical Psychology Forum 2021; 324: 12–16.
6. Hartley N, Coates J, Woodward K, et al. Getting in at the start: clinical psychologists as GPs for mental health. Clinical Psychology Forum 2022; 356: 72–81.
7. Mental Health Foundation. Poverty: statistics. https://www.mentalhealth.org.uk/explore-mental-health/mental-health-statistics/poverty-statistics (accessed 28 Feb 2023).
8. Hodgson K. Inequalities in English NHS talking therapy services: what can the data tell us? Medium 2019; 5 Dec: https://medium.com/healthfdn-data-analytics/inequalities-in-english-nhs-talking-therapy-services-what-can-the-data-tell-us-4f2ba5334629 (accessed 28 Feb 2023).