Sir, – The glaring gap in our mental health services is the absence of a primary mental health and addiction model of care embedded within general practice.
All discussions about “mental health” have an over-focus on secondary care mental health services or the charity sector. The gap between both is the largest unmet healthcare need in the country.
Large numbers of patients present to their GP with severe psychological distress – low mood, anxiety, addiction, self-harm, or a mixture of all these. The distress can relate to social, personal, relationship, financial and safety concerns that disproportionately effect vulnerable groups. This is the bulk of our work as GPs.
We do our best as the first port of call. However, it cannot be acceptable in a modern healthcare service that over 50 per cent must pay for this care – and follow-up – when they have a mental health crisis. Sometimes we prescribe medications. It is very unusual for GPs to refer for psychiatry input. That is essentially the only accessible, embedded care that currently is available to patients.
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Current psychological supports for these patients in primary care are practically absent, and where available are prohibitively expensive or inadequate. There are episodic social supports and projects. But overall there is no model to embed social care professionals within GP. Where key workers are embedded within the GP service, they can prove a game-changer.
We do not have to reinvent the wheel. Other countries, such as New Zealand, have implemented such a model. There the GP is at the heart of the service, it is free and accessible to all patients and it is an unfragmented system.
We urgently need a public discussion and a funded policy direction toward universal primary mental healthcare. – Yours, etc,
Dr MARK MURPHY,
Dublin 8.