Abstract
Mental health in general practice
Approximately one in four adults in the UK will experience mental illness each year (McManus, Meltzer, Brugha, Bebington, & Jenkins, 2009). In general practice we see a vast spectrum of mental illness and disturbance on a daily basis. The number of people accessing mental health services in England has risen in recent years, with over 90% of these patients being treated in primary care, while services are overstretched or cut (England, 2014).
An editorial in the BMJ claimed that ‘under half of GPs have received mental health training’, and called for mandatory mental health placements, and e-learning modules (England & Hawthorn, 2017). This view neglects that the majority of mental illness is seen and dealt with by GPs in primary care. Because our training is in general practice we will encounter, and learn to manage a wide range of (sometimes complex) mental health problems. Moreover, owing to our unique community perspective, we are well positioned to understand the complex interplay of social factors with these illnesses. The RCGP, and the Associates in Training (AiT) committee, have argued for a quality-focused enhancement to general practice training, steering away from prescriptive targets of time in specialist services.
Wellbeing has been a priority of the AiT committee for the past 2 years, and our College is also undertaking work in this area. At a time of low morale in our profession, it is a concern that chronic dissatisfaction and unhappiness may well affect our own mental health. After going through a difficult time myself, a friend brought me a book called ‘Happy’ (Brown, 2016). In it, Brown critiques the ‘power of positive thinking’. Instead of subscribing to the ‘New Thought Movement’, Brown draws on ancient Greek philosophies, suggesting we acknowledge ‘the boundaries of what we [can] achieve and [resign] ourselves to “vicissitudes out of our control”’ (p. 25). This (perhaps ironically) reminds me of Covey’s (1989) ‘circle of influence’ within the wider ‘circle of concern’.
Factors affecting the availability of services to support GPs managing mental health conditions may be outside our immediate circles of influence, although organisations including our College continue to campaign on this matter. However, the support we offer each other, which extends to the work we do to support training and development, is within our collective influence. Rather than adding to the wider rhetoric that shifts system-wide problems to individual GPs, we need to be mindful of the potential risks of illness in our colleagues and ourselves, and support the great work that is done in and by our profession.
A significant development in England has been the evolution of the GP Health Service, open to all GPs and general practice trainees (http://gphealth.nhs.uk). Other sources of help and advice are signposted by our College (https://goo.gl/FqrWHc). Training and working in general practice is tough. As I hand over to my enthusiastic and competent successor (Sophie Lanaghan), I would like to take the opportunity to wish you all well in your futures. Take care of yourselves, and find joy and satisfaction within the great work of general practice.