Mental health, the theme of this month BJGP, has had what might be described as a good press recently. A series of national initiatives, such as Heads Together, have been aimed at removing stigma and encouraging open conversations about mental health problems. Sir Simon Wessely, while president of the RCPsych, commented that Prince Harry’s interview about his feelings after the death of Princess Diana ‘had achieved more good in 25 minutes than I have in 25 years’. The Ban the Bash campaign, initiated by the RCPsych and supported by the RCGP, confronted hostility and stigmatisation towards psychiatry and general practice in medical schools, and argued for parity of esteem with other specialities. The mental health problems of the GP workforce have been recognised by Health Education England’s funding for the recently-established Practitioner Health Programme. However, demand for mental health services continues to rise, and a new report from NHS Providers raises concerns about the gap between aspirations and funding.1 The report points out that mental health trusts look after 1.2 million patients each month, of which 314 000 are active referrals for patients under the age of 19 years, with 42 000 new referrals each month. The majority of their chief executives are worried about funding reaching the front line and over 60% have concerns about staffing. The organisation advocates setting realistic ambitions for what can be achieved, ensuring that dedicated mental health funds reach the front line, and a workforce strategy that is fit for purpose, with STPs and commissioning ensuring that mental health provision is ‘front and centre’ of planning.
A wide range of important mental health topics is covered in this issue, including a blueprint for a new approach to mental health provision in STPs, the results of a systematic review aimed at defining primary care quality indicators for people with serious mental illness, an account of strategies that experienced GPs have found useful in the management of people with medically unexplained physical symptoms, and a disquieting meta-synthesis of qualitative studies on the diagnosis and management of perinatal depression and anxiety in general practice. This last study highlights the consequences of the gradual disconnection of GPs from routine maternity care, the challenges in identifying and assessing the severity of perinatal depression and, reflecting the resource concerns mentioned before, the difficulties that GPs frequently face in accessing perinatal mental health services.
The editorial by Imran Rafi and colleagues draws attention to the report published by the Academy of Medical Sciences on the communication of risk in primary care.2 The authors of this report have cast the net wide, recognising that effective communication of risk depends not only on how to depict and illustrate risks, benefits, costs and adverse effects, but also on the quality of the evidence base for making these judgements. Consequently, the 12 main recommendations of the report encompass the need to ensure that evidence is robust and relevant, that it is trustworthy, and that it is communicated and used effectively. There are implications for the prioritisation and conduct of clinical research, skills in the evaluation of research findings, balance and openness in publication, the declaration of negotiation of potential conflicts of interest, and the role of NHS Choices, which is seen as becoming a central repository of ‘cle, balanced and up-to-date evidence on healthcare options’.
Returning to the mental health theme, some of you may have noticed that we have been publishing a BJGP Library series for the last 2 or 3 years. Our recommendation this month is Human Traces by Sebastian Faulks, an ambitious novel which attempts to get to grips with the origins of psychiatry and of madness itself. If you have read it, and still have an appetite for a novel which shines a powerful light on mental illness, I cannot recommend too strongly Owls Do Cry, an astonishing piece of writing by Janet Frame, published in New Zealand in 1957. Unforgettable.
- © British Journal of General Practice 2017