By Helen Newbigging and Andy Bell
Mental health is much in the media these days, often highlighting the difficulties people can have in accessing specialist mental health services. Most people with common mental health problems (about two-thirds) receive no support at all from the NHS and most of those who do receive any support are helped only in primary care. This includes a growing number of people who are ‘stepped down’ from specialist services (such as community mental health teams) and those who are referred by their GP but not accepted by specialist services. These people often have complex psycho-social situations, implicated in their poor mental health, as well as other conditions.
Whilst there have been a number of initiatives, including Improving Access to Psychological Therapies (IAPT) and physical health screening for people with a diagnosis of severe mental illness, we know relatively little about what constitutes good quality primary mental health care. And there is little evidence about how to improve access to effective support for those who currently do not get the help they need, or about how to fulfil primary care’s role in prevention. We have carried out some initial scoping work to investigate what good practice looks like.
There is little evidence about how to improve access to effective support for those who currently do not get the help they need, or about how to fulfil primary care’s role in prevention
However, we know that what people with mental health problems will have access to in primary care will depend on where they live and the insight and commitment of local practices to support them. This is particularly the case for people with complex needs which might not be neatly categorised and who require a range of support, both psychological and social. The University of Birmingham and Centre for Mental Health are working together in partnership with West Midlands Thrive, and with support from the Royal College of General Practitioners, to identify the components of an effective model of primary care. This will:
- Inform practice in primary care services across England;
- Support CCGs in commissioning effective primary care mental health support locally;
- Inform STP areas and combined authorities in devolved city regions to invest in primary care mental health services;
- Influence policy nationally to support improvements in primary care mental health.
It is highly possible that good work is going on in primary care but not getting the attention it deserves. We are, therefore, inviting primary care practitioners and commissioners to send us examples of approaches and initiatives of good primary care mental health practice. Alongside this, we are undertaking a literature review; visiting primary care practices and undertaking interviews with primary care staff and stakeholders, including service users who are accessing primary mental health services.
We will draw together all of this evidence to produce a composite model of primary care mental health, which reflects current best practice.