Primary care should undergo a series of structural changes to respond to complex and ever-increasing demand for mental health support, which has been exacerbated by the Covid-19 pandemic, a report by the Centre for Mental Health and the King’s Fund has said.
The report, co-authored by the charity and health think-tank, made nine recommendations aimed at helping primary care meet community mental health needs and improve the quality of services.
It found one of the biggest obstacles reported by GPs is that many patients presenting with mental health issues do not fit a clear referral pathway because of the ‘complexity of their needs’.
People have been presenting to practices with mental health issues such as anxiety and depression, alongside other underlying problems, such as ‘inadequate housing, drug or alcohol misuse, debt problems or a history of traumatic experiences in childhood’, the report said.
Local Improving Access to Psychological Therapies (IAPT) services have been unable to offer appropriate services due to the complexity involved, while secondary care may reject referrals as they are not deemed ‘severe’ or ‘high-risk’, leaving patients in limbo, it added.
Beccy Baird, Senior Fellow at The King’s Fund and one of the report co-authors, said: ‘Large numbers of people who need mental health support fall into the gaps between services. This was already the case before Covid-19, and the pandemic now risks exacerbating the problem.
‘We need investment in new services that completely redesign the interface between primary care and specialist mental health services, providing flexible support rather than rigid referral criteria.’
‘Bridging the gaps’
The report encouraged primary care networks to develop primary and community health services specifically aimed at bridging these gaps.
It said establishing community services that provide ‘advice and support’ for wider social needs such as money, housing and safety, could be part of the solution, and ‘may be just as important as clinical care’. It suggested these services could be located in GP practices.
Social prescribing approaches and community link workers ‘also have an important role to play’ in directing people to wider support, the report added.
The report also highlighted the importance of ‘prevention and early intervention’ support, which can include helping people to quit smoking or access physical activities, to deal with mental health issues ahead of crisis point.
‘Impact of Covid-19’
The Covid-19 pandemic means the case for change is stronger than ever, the report said, with intense workload pressures being experienced in both primary care and mental health services, and with potential increases in mental health needs in the population.
The current situation has left GPs having to support people with complex needs that ‘they do not always feel well trained to deal with, with less than 50 per cent of GPs having had formal training on the assessment of suicide risk, and many having no previous training experience in psychiatric services’, the report found.
Often, the only way for a GP to get advice from a mental health professional is to make a formal referral to specialist services, but this causes delays, which could be avoided by creating a more flexible system, it said.
The ‘PRiSM’ primary care service in Cambridgeshire and Peterborough, which offers prompt mental health advice and support to patients following a GP’s ‘request for service’, was highlighted as an example of best practice.
‘A new start for mental health’
The report urged primary care networks to ‘seize the opportunity’ to hire mental health specialists in general practice following the pandemic, with current plans showing they will be included in the funding for additional roles from April 2021.
‘Mental health provision in primary care needs to involve specialists and generalists sharing responsibility for managing the mental health needs of the entire local population,’ the organisations said.
‘This might involve specialists working with GPs and practice nurses to oversee the quality of care provided to all patients with mental health needs, of whom only a proportion would need direct face-to-face intervention from a specialist.’
Having mental health professionals working closely with GPs and other primary care staff also promotes ‘shared learning between professionals’, helping to improve the support they offer, the report said.
It added that those mental health professionals will need ‘professional supervision’ and to be ‘embedded in primary care’ so they do not become isolated from their peers.
Sarah Hughes, Chief Executive of the Centre for Mental Health, said: ‘Primary Care Networks can create a new start for mental health in primary care by acknowledging that they cannot fulfil their core roles without it. Mental health services can [also] reach out to primary care colleagues to help to build a truly ‘whole-population approach’ that leaves no one behind.