Relationships between mind and body have bothered philosophers, and more recently neurophysiologists, since the days of Plato and Descartes. John Eccles and Karl Popper completed The Self and Its Brain1 published in 1977, after strolling around the gardens of Villa Serbelloni in Bellagio, on the shores of Lake Como, arguing for interactionism and the idea of the ghost in the machine. Dualism rears its head repeatedly in medicine, and tensions between the health and health care of the mind and of the body run through many of the articles in this month’s BJGP.
Starting at the beginning, the mental health of children and young people is a huge cause for concern. Childline has reported a recent doubling of calls from children with suicidal thoughts.2 The editorial by Faraz Mughal and Elizabeth England concludes by reiterating the urgent need for more investment, better measures aimed at prevention and early intervention, greater collaboration in providing their mental health services, and more research. These themes are highlighted in the systematic review by Doireann O’Brien and colleagues, who identified the many barriers that impede timely consultation, adequate assessment and effective treatments. Keziban Salaheddin and Barbara Mason found that at least one third of children and young adults with mental health problems had not sought help for them. Barriers included a sense of stigma, difficulties in articulating their problems, and difficulties in accessing services.
In an accompanying editorial, Simon Glew and Beth Chapman consider the training implications of the unhealthy divide between mental health and internal medicine training for general practice. They acknowledge the challenge of achieving ‘parity of esteem’ between the specialties, and call for a focus on better equipping our future GPs to assist patients with mental health needs and, in parallel, enhancing physical health care within psychiatric training.
The President of the Royal College of Psychiatrists joins forces with the Chair of the RCGP in condemning the continuing and destructive professional denigration of both psychiatry and general practice within medical schools. Negative, not-so-friendly banter has become a tradition that ‘... stigmatises mental health, contributes to a shortfall in GPs, and ultimately puts our patients at risk ... (it) has to stop’. The RCPsych has launched the #banthebash campaign to address Badmouthing, Attitudes and Stigmatisation in Healthcare, and the RCGP will also be campaigning against the denigration of general practice. A more familiar form of bullying is the topic of another editorial, by Emma Scott and Jeremy Dale, in which the implications of childhood bullying for the mental health of children and for their care in general practice are described. Over half of children in England are bullied and severe bullying is often undisclosed. They comment that ‘Enabling more consistent disclosure and appropriate intervention in general practice may help to prevent the health and social consequences of bullying that can otherwise plague individuals for a lifetime. In this way the GP can help to break the circle of silence that surrounds bullying, which so often leaves young people feeling isolated and trapped, and so help the young person to understand what is wrong without overmedicalising their situation.’
Other mental health topics covered this month include the difficulties surrounding long-term antidepressant use, and the dialogue needed to adequately discuss the option to discontinue treatment, the feasibility of CBT to help frequent attenders in general practice, and the need not only for training but also for personal support for GPs trying to help parents bereaved by suicide.
Finally, and just in case you need reminding that doctors are not exactly immune from mental health problems, Clare Gerada’s account of therapeutic doctor-only groups for physicians with problems is a timely and salutary reminder of the vulnerability, fragility and sometimes tragedy that we walk with every day. We need to take the care of our own health as seriously as we do that of our patients.
- © British Journal of General Practice 2016
