Editors & Views Editor
Glasgow Guardian investigation reveals that Uni's broken promises threaten student mental health care
A Glasgow Guardian investigation into University Barclay Medical Practice found that 47.1% of respondents rated their treatment as poor or extremely poor.
The responses indicated a clear discrepancy between treatment for physical and mental health. Where physical health was concerned, 47.8% reported treatment to be good or very good. This figure fell to 18.4% for mental health, with the largest group of respondents (44.6%) describing treatment as "neither good nor bad", and 37% as bad or very bad. When asked to compare the University Barclay Medical Practice with their experience of other GPs, 66.9% of respondents said it was worse, and only 10.2% said it was better.
In conjunction with the survey, The Glasgow Guardian interviewed seven University of Glasgow students on their experience of seeking mental health treatment from University Barclay Medical Practice. The seven participants were all female, and reported mental health problems which included depression, insomnia, emotional instability, generalised anxiety disorder, seasonal affective disorder, eating disorders and PTSD. Five out of seven had been treated for mental health problems before registering with Barclay GP, and two had never previously received mental health treatment. Previous mental health support the participants had accessed included: GP treatment, Child and Adolescent Mental Health Services (CAMHS), NHS Crisis Team, Cognitive Behavioural Therapy (CBT), counselling services, and medication.
In both studies, participants consistently highlighted the same failings of Barclay GP to make support accessible: the 8am drop-in service, lack of access to a consistent GP, and dismissive doctors or unhelpful reception staff.
The University Barclay Medical Practice provides an 8am drop-in service for patients to make appointments. Though Barclay's website indicates that it is possible to make appointments over the phone, respondents mostly found that treatment was only available by drop-in. 81.8% of survey respondents found that the drop-in system made it more difficult for them to make an appointment, and 78.5% reported that the drop-in system had discouraged them from seeking treatment. Five of the students interviewed by The Glasgow Guardian found that the drop-in prevented them from seeking treatment, and none found the system helpful.
One anonymous participant said: "I think the biggest failing is the on-the-day appointment system; having to spend ages trying to get through at 8:30 to be told they have no appointments left is not good, and telling students to be in at 8am to guarantee being seen is unrealistic, particularly for mentally ill students."
Jo Cardwell reiterated the difficulty of attending drop-in with a mental health problem: "The drop-in service has been detrimental in requiring treatments. I would often put off going to the doctors as I found it difficult and anxiety-inducing for me go have to go and wait potentially hours to be seen. It is really difficult to motivate yourself to get up and go and wait ages for an appointment, especially when you're going through a bad patch."
Cardwell continued: "When I'm at a bad point, I struggle to get out of bed or leave the flat, and the idea of having to be at uni early to get an appointment is not something that I could do. The drop-in system also means that somebody may not have medication when needed, and I have experienced trying to get an appointment for days with no success."
Of the two who did not consider the system actively detrimental, one anonymous participant remarked: "As it's still very early, [the participant has been registered with the practice for two months] I have not noticed any large detrimental effects of the appointment system, but it has made me quite anxious about getting medication in future knowing that there could possibly be a delay whenever I try."
The other, Emma, said: "Detrimental is a strong word, I think, but I have avoided going to the practice to seek guidance just because I know they will have nothing to tell me other than there is a long waiting list and if I don't want to wait, then I have to pay for private."
While 44% of survey respondents found the lack of access to a consistent doctor detrimental to their treatment for a physical condition, this figure rose to 79.7% of respondents reporting mental health problems. Similarly, all seven interviewees agreed that consistent treatment from one doctor would be beneficial.
"An established doctor for patients would be beneficial as I really struggle with cohesion in my mental health care," said Caitlin Byrne. "For example, at Barclay Medical, in the two years I was a patient I saw the same doctor around three times. It didn’t help as I had to constantly repeat myself, my medical history, and found it hard to disclose certain symptoms to some of their GPs."
Every interviewee also agreed that doctors scheduling future appointments on patients' behalf would be beneficial. On the subject, Jo Cardwell said: "Consistency and accessibility is so important for those with mental health issues". The importance of consistency in mental health care was similarly emphasised by other interviewees.
"Patients with long-term conditions, mental health or otherwise, should be able to book appointments in advance. It’s the consistency and continuity that helps people with long-term conditions the most in my opinion," Caitlin Byrne continued. "As my previous GP allowed scheduling of future appointments on my behalf, it was extremely useful and beneficial as it would reduce the amount of stress experienced when trying to make an appointment for the same day drop in service either in person or over the phone."
An anonymous participant also commented: "It really helps to maintain a consistent GP, which, when discussing personal matters and especially with mental health, is good so you don't have to repeat everything constantly (particularly when explaining the source of trauma, as in my case)."
The survey revealed that 44.9% of respondents felt that doctors at Barclay didn't take them seriously when reporting a mental health concern, and 25.6% were unsure. While two interviewees remarked on friendly or helpful doctors, the other five could think of no positive aspect to their treatment at Barclay, and two felt as though their mental health concerns had been dismissed. Participants are aware of inconsistent treatment at the practice, with one person commenting: "The quality of treatment varies hugely depending on which doctor you are lucky or unlucky enough to see."
Jo Cardwell said: "Some of the doctors are very dismissive and make you feel like you've wasted their time when you come to them saying you're suffering from depression/anxiety, which is what I was and still am struggling with. [...] I was made to feel as though my issues weren't important, and that I was fine even though I knew there was something more. It's difficult to tell your doctor you disagree with what they're saying, and I didn't have the confidence to do so, which just made me feel worse."
Hannah Patterson added: "I felt that in other GP practices I was taken more seriously than in Barclay GP - Barclay treated my issues as 'exam stress' and said that they would resolve on their own, as opposed to a relapse into a long-term mental illness. I was told to go away and come back if it wasn't better in a few months."
When asked if doctors were sufficiently informed on University procedures for mental health, 47.3% of survey respondents were unsure, and 33.6% were unsatisfied. Six out of seven interviewees believed that doctors being more aware of University practice and having better training on mental health treatment would be beneficial. When the interviewees were asked if Barclay Medical Practice was suitably integrated into the University's procedure for safeguarding mental health, Caitlin Byrne commented: "Surprisingly, the doctors have been really good with me in terms of the Good Cause procedures. They have always given me notes as evidence when required, and free of charge too."
Byrne continued, however, to say: "Doctors should definitely be more aware of the University’s practice regarding mental health. I’ve been to Barclay in times of crisis, with suicidal ideation, yet I’ve never had my concerns escalated which I felt to be inappropriate. I feel as if this is an issue all GPs need to be retrained on, as mental health treatment to them seems to be giving you a prescription for SSRIs or other antidepressants, telling you 'try not to kill yourself' and telling you to come back in a few weeks time. There needs to be a lot more compassion and ability to provide you with more appropriate resources."
Jo Cardwell stated: "I don't think they effectively protect students with mental health issues, and I don't think that they work alongside the university procedure for this."
Emma was similarly unsatisfied: "I don't think that the Barclay GP is suitably integrated into the University's stance on the importance of mental health."
Similarly, Hannah Patterson said: "They don't seem to have any idea how to deal with mental health in my experience."
As one of the four interviewees currently registered with the University's disability services for a mental health problem, Bethany Woodhead said: "Especially regarding the mental health of students as a population – which is notoriously bad – it would be ideal if the practice linked up with the Uni mental health services to support one another so that the best treatment and support can be offered to the student from both ends." Woodhead continued: "Perhaps the University disability services could flag students to the GP practice. Then, a letter or call inviting them to a doctor’s appointment can be made, to make accessible to students all the necessary support while at uni (and vice versa)."
Without prompting, eleven participants across the survey and the interviews raised the issue of unfriendly or unhelpful reception staff.
Caitlin Byrne commented: "the receptionists need to recognise the urgency of needing a GP appointment if you have a mental health condition. People who either suffer from diagnosed mental health conditions or think they’re suffering with mental health problems are routinely told by the NHS to go to their GP as the first point of call when they’re struggling. How can they do so when the system is incoherent and does not allow you to book appointments?"
An anonymous participant said: "I think training would also be useful, but I feel that this would benefit the reception staff the most as it felt quite accusatory to have it suggested to me that I have left everything to the last minute when I had been trying to get seen for at least a week by this point."
Six of the seven interviewees noted consequences to their mental health due to current procedure at Barclay. These consequences ranged in seriousness, and included missing medication or avoiding seeking treatment.
Hannah Patterson elaborated on how her mental health deteriorated due to insufficient care: "After several visits to Barclay asking for counselling, I was eventually put on medication. There were no follow up appointments and these medications sent me into a particularly bad spiral, leading to a suicide attempt and having to take a year out of uni to receive treatment at home. While I cannot say that this wouldn't have happened regardless of their treatment, I do feel like the lack of follow up after starting a new medication (one with suicidal feelings as a listed side effect) and their resistance to offer me any help at all heavily affected my relapse."
Caitlin Byrne similarly experienced a negative impact on her mental health due to procedure at Barclay: "if I needed medication changes etc, Barclay GPs were hesitant in doing so as I’d already been referred to a psychiatrist. Psychiatrists will only see you once every four months or thereabout, and so by Barclay GPs refusing to review my medication I’ve had withdrawal from SSRIs and other antidepressants. Withdrawal can be extremely dangerous and I’ve ended up in hospital as a result."
Another anonymous participant commented: "Because of the issue with getting an appointment [...], I have been forced to get an emergency prescription from the Pharmacy because I could not get my meds after not having them for a few days (quite a dangerous situation when a new student in a brand new area). This meant I had to pay £17 for a two week supply as emergency prescriptions are not an NHS service. The pharmacy rang the GP who didn’t seem to even have a record of my registration at this point, despite it being a good few weeks after I registered".
The Glasgow Guardian understands that the Barclay Medical Practice is an independent practice that rents space on the University of Glasgow campus, and the University have been reluctant to confirm an established relationship with the Practice beyond this. However, documents obtained by this paper show clearly that the University offered assurances to concerned staff, students and SRC representatives that the Practice's performance in relation to University services would be "regularly reviewed".
In 2008, the University produced a report to the University Court recommending that the existing University Health Service (UHS) on campus should be closed down and replaced by an NHS practice (which would become the University Barclay Medical Practice). Documents obtained by The Glasgow Guardian reveal that serious concern was raised by students, staff and SRC representatives at the time of the report, with particular emphasis on the impact this would have on mental health services for students.
On January 14 2009, the University's Health, Safety and Environment Committee expressed "serious reservations" about the Court's decision to introduce a new model of health service provision (including the decision to close the UHS). One of the key concerns was that "the current level of mental health provision and support [offered by the UHS] would not be maintained". This concern was also raised to the University Court in December 2008.
In response to these reservations, the University assured the concerned parties that "discussions are ongoing with the Barclay Practice about administrative arrangements to ensure that referral routes for students and staff are clear and effective". It also stated that the Barclay Practice would give a "range" of services to the University's departments, including "advice on student health issues". The statement claimed that these principles would be reflected in the Service Level Agreement with the Practice, and that "its performance in meeting departmental needs will be regularly reviewed".
The Glasgow Guardian can also confirm that many students contacted the SRC to express their concerns about the decision to close down the UHS and replace it with an NHS practice. While the SRC expressed support for the decision, they asked for some guarantees from the University to address issues raised.
In an email obtained by this paper, we can confirm that the SRC requested guarantees that any new service maintains a "speedy referral service" so that students can "remain studying or return to studying quickly," raising that the seven week minimum NHS wait time for a referral would have a "serious impact" on a student's capacity to continue their studies.
The University Court also received submissions from concerned members of staff in December 2008, claiming that an NHS service could not provide the "bespoke" service to staff and students that the UHS provided. They also raised that the UHS was "particularly effective" in the area of mental health, and that there would be an "impact in this area". The Glasgow Guardian can confirm that as part of this submission from staff, the University's Student Counselling and Advisory Service was concerned about the impact of any changes to its work.
When approached for comment with the issues this investigation has raised, the University Barclay Medical Practice were extremely responsive. In a phone conversation with The Glasgow Guardian, Dr Des Spence - one of the practice's six Managing Partners - was very keen to ensure that the practice is better integrated with the University's processes and services for mental health. He has told The Glasgow Guardian that the practice is "open to change" and that they are "genuinely trying to do something different" and "will take on board any criticism".
Dr Spence expressed concern that the problem with mental health care specifically is that it's "not very joined up", and that while the University puts a lot of work into mental health services,
"patients feel stuck in the middle - they don't know how the services work, or they find that services aren't responsive".
Aware that mental health services are struggling, Dr Spence has suggested to the University that they organise a mental health summit open to all students in order to develop a new strategy, stating that the practice would meet all costs of this summit.
Other Barclay practices have a Community Psychiatric Nurse (CPN), and Dr Spence has told The Glasgow Guardian that they are considering whether this should be implemented at University Barclay. They also recently launched video consultations via Skype that are possible to be booked with a specific doctor - these are designed to benefit students with mental health problems, with an emphasis on accessibility and continuity. These consultations last fifteen minutes.
Dr Spence has told The Glasgow Guardian that he is happy to meet with SRC representatives to discuss student concerns about the practice.
Despite assurances made by the University that it would work closely with Barclay Medical as it was replacing an existing University health service, a spokesperson for the University has said: "the University is committed to ensuring that our students and staff have access to appropriate health care, including mental health provision. There are many GP practices in and around the West End of Glasgow for students and staff to choose from, and this includes the Barclay Medical Practice which is an independent practice based on campus."
SRC President Lauren McDougall has said: "Regardless of the detail of the agreement between the University and the Barclay Medical Practice, the service is perceived by students to be the University’s GP surgery and serves a huge proportion of our student community, therefore there is a responsibility on both sides to ensure that the service offered is fit for purpose.
"When the University Court took the decision to close the UHS there was a guarantee that any new service would be integrated with the University’s processes and policies around student health and wellbeing, however this hasn’t been put into practice and as a result students feel let down. As a student with chronic health conditions myself, I have experienced a lot of the same difficulties as the respondents to the Glasgow Guardian survey and have raised these issues directly to senior University staff over the last year with the hope that there can be a review of the Service Level Agreement. I’m pleased to hear that there’s a real willingness from Dr Des Spence to work with the SRC on this, and I will take this forward."
The Glasgow Guardian would encourage any member of the University community with concerns about mental health treatment at University Barclay to raise the issue with the SRC so that this can be communicated with the University Barclay Medical Practice as well as the University itself. Although the University is seemingly distancing itself from the practice, University Barclay is perceived to be the University's official GP due to its space on campus; this alongside previous assurances made by the University suggests that it holds a responsibility to work closely with the practice. The Glasgow Guardian strongly encourages that the suggested mental health summit proposed by Dr Spence take place so that the University community and practice can work together to develop a strategy that can address the mental health crisis facing students.