Innovating to break the stigma towards mental health
Using innovation to incorporate mental health support and services into GP practices.
Delivering timely, effective and well-integrated mental health services to the population is a challenge faced throughout the country. Service users and carers want treatment and mental health support close to their home, in the least stigmatising environment possible. GPs want closer links with mental health experts, who can provide quick and easy access to advice when needed.
We know that there is a lot of unmet mental health need in the community and we also know that early identification and treatment delivers much better outcomes for people.
For many people with mental health difficulties, whether that is common problems such as depression and anxiety or a more severe problem such as psychosis, the referral routes between primary — mainly practice-based — and secondary — hospital-based — care can be complex and confusing.
Referrals between GPs and hospitals can be significantly delayed and after waiting, people often find that referral criteria for specialist secondary services are not met. This can leave people with mental health difficulties feeling rejected, unsupported, and confused.
Camden and Islington NHS Foundation Trust has responded to this challenge with an innovative new service.
It has created new “practice-based” mental health teams in Islington and in the south west London borough of Kingston to provide mental health expertise and treatment in GP practices.
The model, co-produced with service users who collaborate via an advisory committee and a dedicated network, supports the integration of physical and mental health care — a priority in NHS England’s Five Year Forward View.
The teams consist of a range of disciplines including psychiatrists, psychologists, pharmacists, mental health nurses and social workers. They establish close working relationships with GPs, practice managers, nurses and other primary care partners to provide easy access to help, support and advice.
The teams offer consultation and advice to primary care staff and direct assessments of service users in GP practices.
For some service users, they offer a joint consultation with their GP, which helps to further integrate the service provided to that individual. One recording system is used by all partners, facilitating timely and joined up communication.
Feedback from service users and GPs is very positive. GP Dr Kathleen Tuck (right), is a partner at The Miller Practice, Highbury New Park, Islington, where a mental health team from C&I has been visiting the practice for about 12 months.
She said the arrangement had led to much closer links with a consultant psychiatrist and a clinical psychologist who attend the practice each week. She said: “From the GP perspective, it’s led to clearer communication channels, easier referral methods and easier access to advice in managing patients.”
There is also evidence from initial analysis that the practice-based teams increase the capacity for mental health problems to be managed solely in primary care, without the need for onward referral — 30% fewer referrals to secondary care services from the Islington practices with the service.
Charlie Ware, a service user registered with the Goodinge Health Centre, North Road, Holloway, Islington, said: “Having this approach meant that during a recent crisis period I was able to see a psychiatrist, psychologist, and psychopharmacologist quickly and conveniently at my GP’s surgery.
“The integration of the service into the practice setting allows for a quicker and more responsive approach, information can be directly shared with my GP who is better supported in the longer term job of managing my treatment and evaluating my progress.
“It also helps me see mental health care as part of my overall health care which helps reduce the sense of stigmatisation that dealing with mental health issues can so often create.”
This service is currently in development. There are plans to roll it out across Islington over the next six months, from ten to 34 practices, and in the future, to incorporate support in practices for those with serious mental health difficulties who are stable on treatment but traditionally kept on in secondary care outpatient clinics or recovery teams.
Dr Josephine Morgan, Consultant Psychiatrist, Camden and Islington NHS Foundation Trust
Dr Josephine Morgan is a Consultant Psychiatrist with Camden and Islington NHS Foundation Trust (C&I) and Clinical Lead for its Islington Practice-Based Service, working with its Central Islington Practice-Based Team. She has been working as a Consultant in primary care for three years, and been involved with the development of the practice-based service since a pilot in 2015. She is enthusiastic about making support for mental health conditions more accessible to all, and improving communication within the NHS.