Laurie Clarke discusses the ‘Treatment by Leaflet’ phenomenon that too many GPs use to ‘cure’ mental illness
My relationship with the GP began in earnest in the winter of 2010 when I decided I wasn’t going to school anymore. My parents were stricken, my teachers were confused and I was certain of one thing – I wasn’t going back. But sixteen year old girls seldom get what they want, and in the office of a kindly GP I was told that this was normal, that I was hormonal, and I did, reluctantly, return.
Until the winter of 2012, when I wouldn’t get out of bed.
In the ensuing five years, I was flung from GP to GP, from CPN to CBT, counsellor to therapist. You could consider me a crash test dummy of mental health services. I was told a lot of things, given a lot of leaflets, and prescribed a lot of drugs. I became intimately acquainted with the GP.
Given the combative nature of securing an appointment, I ended up seeing a lot of doctors, all of whom treated me differently. There were doctors who made me cry, doctors who told me to go back to university, and one who actually helped.
But this lucky dip of doctors requires patients to constantly start from square one, condensing however many years of personal history into a five minute slot. It’s like trying to tell a story where the listener keeps leaving, only to be replaced by somebody else. The result is so fragmented and impersonal that further discussion is almost impossible. Add to this the difficulty in even making an appointment, and patients with long-term mental health problems will often face unplanned gaps in medication and prolonged, ill-advised stretches with no professional help whatsoever.
Due to a lack of availability, I found myself having no choice but to consult with doctors who didn’t know my medical history, and as a result they were reluctant to make decisions regarding my treatment. This is a problem many students may encounter, should they choose to register with a practice local to the university. It’s no secret that students and stress go hand in hand, but begin the discussion of mental health with a GP and you’ll likely leave with little more than a fistful of leaflets and meditation tapes. This may be sufficient to support students dealing with stress surrounding exams or the adjustment to university life, but it’s profoundly ill-equipped for those with long-term or serious mental health problems.
The university’s Barclay Medical Practice is no exception. As another academic year commences, the university medical practice will face an influx of new and returning students. But are they adequately equipped to withstand the complications faced in the average student’s lifespan? After a year contending with drop-in appointments, irregular access to medication and no established consultant, I’m not convinced.
I’m all too aware that the NHS is struggling to cope, but all I’m asking for is a modicum of common sense. I think that GPs can do more in an individual capacity to support patients with mental health problems. This could mean ensuring that patients who require frequent check-ins for longstanding problems have an established doctor with whom they can maintain regular contact. It could mean making appointments on behalf of a patient, to ensure that their wellbeing or medication can be reviewed at an agreed time. Many patients with mental health problems often find it difficult enough completing such tasks, never mind the added stress of being told that there is nothing available for the foreseeable future. It could simply mean showing a little curiosity, attempting to gauge the situation with each patient, instead of relying upon popular go-tos like a beginner’s guide to meditation.
Patients are accountable when they miss appointments, and I myself have received my fair share of warning letters after failing to make it out of the house. But this stems from concern over wasted resources rather than the patient’s well-being. If you miss an appointment with a therapist, counsellor, or any other practitioner of this kind, a follow-up would be necessary to account for their absence. Why, then, should the protocol be so different when dealing with a GP – arguably the first line of defence in mental health support.
However, the issue of how young people’s mental health is treated by the GP extends beyond irregularity of appointments. ‘Treatment by leaflet’ has reached epidemic levels: if you’re a young person with a long-term mental health condition, finding a good GP is too often a lottery of luck, and many young people in crisis continue to be told that a change in diet or exercise is all that’s needed. The fact is that mental health is not yet treated with the same respect as physical health, and as long as medical professionals treat mental health issues as a mere side-effect of bad student habits, wider society will too.