A new survey from Pulse has revealed how the pressure on mental health services has led to GPs having to provide specialist mental health support that they say is beyond their competence.
The survey of 569 GPs, which looked at the effect of the Covid-19 pandemic on mental health services at the GP level, found that 70% were providing mental health support outside of their competence to children, and 63% for adults.
Pulse reported that GPs were also having to provide:
- Dealing with suicidal ideation in adults (86%).
- Dealing with mental health crises in adult patients (81%).
- Monitoring patients who should be monitored by a specialist team (70%).
- Diagnosing children and adolescents with mental health issues (69%).
- Dealing with suicidal ideation in children (66%).
GPs are seeing a massive increase in mental health problems in consultations: pre-covid only 25% of consultations had a mental health element, now the level is at 38%.
However, when the GP needs to refer a patient to specialist services, they are finding it increasingly difficult to get patients the specialist help they need, as local trusts have raised the thresholds for both adult and CAMHS referrals.
Referrals are continually rejected, noted many GPs, even when they state clearly that they can progress no further and there are no other options. Waiting times for some specialist services – such as ADHD and autism assessments for adults and children – are now exceeding 18 months.
GPs are having to tell patients to go private, but for many patients this is not an option.
Dr Richard Van Mellaerts, a GP in Kingston upon Thames and BMA GPC executive officer, told Pulse that: ‘The wait time for CAMHS is so long now that it becomes almost useless for all but the most significant and serious of mental ill health. And if patients lack the resources to go private, they are left in limbo.’
NHS England is working on changes to mental health services, including the introduction of mental health waiting-time standards, which include a 24-hour target for urgent mental health care. However, any introduction of such targets will be subject to Government approval.
And HSJ has seen a report on child and adolescent mental health services by Getting it Right First Time, an NHS England national programme, which contains 21 recommendations for changes to CAMHS services. This includes a recommendation for a major change in funding – moving to a system of funding by outcome or “therapeutic models” rather than the current ‘payment per bed day’ model. Other recommendations include a clear strategy to reduce the number of young people remaining in inpatient units for more than 60 days, and the implementation of new models of community care for young people on crisis pathways.
CAMHS is one of the most under-resourced areas of mental health and has relied for years on the private sector for capacity, despite regular damning CQC reports on services and hospitals.
All these changes, however, revolve around having adequate numbers of the right staff in the right place at the right time, and there is a heavy emphasis on community care. So despite all the good intentions of these recommendations and the introduction of waiting time targets – nothing will change for the better unless the lack of capacity and staff is addressed.
As The Lowdown has written about time and time again, the increase in mental health need in the population was clear prior to the pandemic and the escalation in need driven by the pandemic was widely predicted and is now fact, so there is no excuse for funding not to have been put in place well over a year ago.
Just for the area of eating disorders, which has seen an ‘explosion’ in demand in the past two years, the NHS Confederation has recently called for £12 million in extra funding over the next two years to ensure that children and young people’s eating disorder services are back on track.
The government needs to address children and young adults’ mental health needs with the same level of attention and extra funding, as it does elective care waiting times, say NHS mental health leaders, and this needs to run alongside a further commitment to roll out mental health support teams in schools and colleges nationwide. The Government’s target is 25% access to mental health support teams and this needs to be increased to 100% blanket coverage so that every school and college has a support team in place.
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