Practices should intervene earlier to improve mental health care, says senior GP

GPs need to intervene earlier to prevent people with minor mental health problems ending up in hospital with more serious illness, a senior RCGP figure has said.

Depression: early intervention can keep patients out of hospital (Photo: JH Lancy)
Depression: early intervention can keep patients out of hospital (Photo: JH Lancy)

Dr Ian Walton, newly appointed clinical champion for mental health at the RCGP and vice chair of Sandwell and West Birmingham CCG, said primary care also needed to tackle the underlying causes behind poor mental health before trying to treat the psychological symptoms.

He cited the successful 'books on prescription' scheme that began in his local area as a cheap and effective measure to keep patients in primary care.

Socioeconomic factors, such as unemployment, homelessness, poverty and family problems, can all contribute to mental health issues.

Speaking at the 2014 annual NICE conference in Birmingham this week, he said: ‘Why do we have services where you have to be significantly mentally ill before anyone comes to help you? A lot of people have minor mental illness, and if you treat them you reduce the number of serious mental illnesses too.’

Dr Walton told the conference that the key to good mental healthcare involved working to support people with lesser mental health problems before these could develop into worse conditions.

He said: ‘Currently, 90% of mental health money is spent on keeping just a few people in hospital beds. It costs significantly less to deal with prevention and tackling the underlying causes.’

A friendly, proactive care service

In Dr Walton's area, a 'proactive and friendly' service introduced by Sandwell and West Birmingham CCG resulted in a 4% drop in ‘did not attend’ rates, which have long been a problem in treating patients with mental health conditions.

Local GPs gave patients with depression the option to choose their preferred method of treatment. GPs sent information to a ‘call-back hub’, which then phoned patients to offer and advise them on available services.

One of their successful methods of improving patient mental health involved GPs prescribing library books.

Dr Walton said: ‘We started with books on prescription, and trained librarians in wellbeing. Patients, some of whom had little experience reading, ended up reading and socialising with classes put on by the librarians and meeting friends at the library. We got to improve the community.’

He said this scheme, which has now been rolled out nationally, was set up at little expense to the CCG, aside from the initial librarian training costs.

Dr Walton said the system, by helping and keeping patients in primary care, resulted in reduced hospital admissions in the Sandwell and West Birmingham area. This in turn allowed secondary care staff to better and more personalised care, he said.

'We freed them of patients who shouldn’t have been in that system,’ he said.

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