Family doctors feel unready to order mental health services, polls find
Mental health campaigners fear that a "postcode lottery writ large" will leave vulnerable people without care as doctors indicate they do not want to take on responsibility for services for the mentally ill.
The government's health white paper last week proposed a massive shake-up of NHS mental health services, stripping primary care trusts of the power to commission services and handing the budgets to GPs.
But two polls of family doctors have revealed that an overwhelming number don't feel able to take on the role of providing services for patients with mental health problems. In the first, by the charity Rethink, more than three-quarters of GPs said they didn't feel equipped for the role, while the same proportion were happy to provide for patients with conditions such as diabetes and asthma.
Rethink says that without a national plan to train GPs, an estimated 1.5 million people with severe mental illnesses will not get treatment.
Paul Jenkins, chief executive of Rethink, said: "GPs with a real interest in mental health can play an invaluable role. But we often hear from people with mental illness that GPs don't understand mental health and want to quickly refer them on to specialists. Now GPs themselves are telling us that they have concerns too."
A second survey by the doctors.net website found two thirds of 232 doctors polled did not welcome the revolution proposed by the health secretary, Andrew Lansley. Asked if GPs were adequately equipped to take over commissioning, four-fifths said no.
The shadow health secretary, Andy Burnham, said the effects of the changes would be a "postcode lottery writ large". "The effects on the most vulnerable, the mentally ill who need to be looked after, just doesn't bear thinking about," he said. "It makes me want to weep."
Professor Steve Field of the Royal College of General Practioners said GPs would need to take advice when dealing with mental health issues. "I wouldn't say that GPs should be commissioning mental health services without expert advice," he said. "No one is expecting GPs to make all decisions about everything, particularly straight away. I really do understand the risks but if we get this right – well, I am an optimist."
The new fears for mental health patients come as deep cuts are being made in services across the country. In south London, two psychiatric wards face the axe, while the Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust will suffer a 12% cut to its budget over the next four years.
Paul Farmer, chief executive of the mental health charity Mind, said there were increasing reports of services being cut. Mind has seen a huge increase over the past two weeks in the numbers of people contacting it worried about possible cuts to incapacity benefits, closures of drop-in centres and threats to other services. "There is no question there is a lot of anxiety," Farmer said. "The fear is very real and it's very important the government recognises that. There is always a concern when times are tight that mental health gets treated disproportionately negatively.
"Some GPs who understand will be brilliant, but then that is not a given across the board. There is still an instinct for some GPs to reach for the pills a little quickly – we have 36 million prescriptions a year for anti-depressants, the vast amount at primary care level."
The previous system, he added, had been far from perfect, because many PCTs lacked sophistication in their approach to mental health.
Lord Victor Adebowale, head of the charity Turning Point, said he shared Paul Farmer's concerns but that the charitable sector would attempt to help GPs. "Turning Point has been delivering services to the public and is effectively a public servant, so to the extent to which more is expected of us, well it was ever thus. The government has to clearly define commissioning so that individuals and communities get the services they need so that commissioning doesn't become a game, a cherry picking of lucrative markets without accountability."
At the moment, people are referred to mental health services by a GP or through A&E departments, police, courts, prison, services for homeless people and other charities. Some mental health services can be accessed without a formal referral. Around 300 people out of 1,000 will experience mental health problems every year in Britain. Of those, 230 will visit a GP, taking up 10% to 20% per cent of a GP's time. This figure is rising, particularly in areas where the local psychiatric hospital is being closed and where unemployment, a key factor in depression, and other mental health conditions, is rising.
This article was originally published here.