Emma Nelthorpe, Lead Primary Care Mental Health Practitioner talks about her role as part of the multi-disciplinary team within Doncaster South PCN. Her team see around 24 patients a day with a variety of mental health-related conditions.

Around 40% of GP appointments are mental health related and the majority of our patients come from GP referrals.  They’ve contacted their GP for help and they’ve been referred to us as the practice team has identified a potential mental health need.

Our team consists of two mental health specialists who see around 24 patients a day, offering half hour or hour-long sessions based on the complexity of the issues involved.

We encounter and assess a huge variety of conditions, including complex mood disorders and various anxiety disorders, some patients may be struggling with past traumas such as PTSD that have an impact on their current mental health, personality disorders such as emotionally unstable personality disorders (EUPD), bipolar queries, and patients that were previously under secondary mental health services who are starting to show signs of relapse. We do at times assess patients who are experiencing psychosis. We tend to see a lot of patients whose main concern is their anxiety including health anxieties, low mood and stress – work related stress seems to be on the rise at the moment.

Hormonal changes are also increasingly touching on our remit – we do have patients that have PMT or are starting with or in the menopause which is affecting their mental health.

We also help people navigate bereavement – we deal with a lot of cases where patients feel they can’t cope with this difficult time in their lives. It’s a grief cycle that the patient needs to go through, but they just need some support. We offer them that that support for as long as they need it. So they’ve got somebody to talk to – so they’re not feeling on their own.

Working with GP surgeries

The reason we’re in the GP surgeries is to be more accessible, people are less likely to reach a crisis point because they’ve got the support they need early on and in their local area.

We’re also reducing pressure on GPs as we’ve got half an hour to spend with patients where GPs often have just 10-15 minutes where they might be trying to discuss lots of different things – the physical health along with mental health.

We offer face to face and phone reviews, this is positive for patients because those that are struggling with their mental health or anxieties sometimes don’t want to travel or feel too anxious to speak to a professional face to face. We give them the choice so we can start building that trust and doing some therapeutic work with them from the first appointment.

For some patients our role is more of a triage. We can carry out brief interventions with them if needed, and we can prescribe if that’s indicated, or we may signpost on to where the person can access support for their individual needs, whether that be talking therapies or other specialist services.

I’m a prescriber so I can also carry out medication reviews which really helps reduce the pressure on GPs – for an example if a change of dosage is needed for an antidepressant medication, I can make that happen.

GP surgeries are getting much better at using our service which is great – we’ve got the specialisms, we’ve got the tools, we’ve got the time. We want to reduce the pressure on GP appointments – that is why we are here.

We work closely with the Primary Care Mental Health Hub – this is a big multidisciplinary team including roles such as CBT therapists, assistant psychologists, mental health workers, health and well-being practitioners. Once we refer them in, there’s lots of different holistic support that they can get at the same time as mental health support. It could be housing or employment support for example. We also work closely with community support services such as the community connectors from Mind, or the Patient Focused Group, where the aim is to get patients integrated with support that is available within their own area.

Positive impacts for patients

Talking therapy is not just ‘Talking’. We try and educate patients on the different types of therapies or different types of support that they can access – just because they feel something’s not worked before doesn’t mean that we can’t try something else. We also encourage patients to access self-help tools that they can use at home.

I saw a patient this morning who was experiencing work related stress, and they feel they can’t change their job due to financial factors. We recognised this job is having a negative impact on their mood. Within my clinic, I’ve referred the patient on to working with employment support to explore available options including possibly gaining funding to re-train in a different profession. I’ve also referred them on to talking therapies where they can gain psychosocial support around learning how to manage stress and improve coping strategies. So, while they still work there, they can hopefully manage their stress a bit better.

Mental health sometimes can be a bit of a revolving door, somebody might have been stable on an antidepressant for a long time, but they may start to struggle with their mental health again. Some patients automatically think their antidepressant is no longer working, but it probably is. It’s just that they’re now struggling with new stress that’s happening, a new thing that is happening in their life.

For some patients it might be the first time they’ve ever struggled with their mental health such as experiencing low mood or anxiety which can be scary for them. Asking for help can be very daunting. They may benefit from being supported to access therapy to learn ways of coping with things that impact their mental health, or how to manage their own anxiety, rather than automatically prescribing medication.

Some appointments can take time, especially if somebody’s very anxious or very low in mood. It can take time to unpick what is really happening for the patient, whilst also looking at potential risk because sometimes they’ll say no, I don’t get any suicidal thoughts. And when they start to relax, they’ll say, well, actually, I did try to commit suicide last week, but it takes time to build that trust, so they feel comfortable to open up.

In our patient feedback surveys we’re scoring 100% on questions around ease of access and how well patients feel they are being helped and listened to.  A lot of patients have said they didn’t know we existed and thank us for taking the time to listen to them. Some patients feel they are now getting the help they’ve needed for a long time but didn’t know where to access it or what was available for them, we have even had feedback saying we have saved their life, and they now see a positive future for themselves.

I’ve worked 15 years in substance misuse, so this role is very different. In GP surgeries you’ve got patients that are coming to you because they genuinely want help and support to improve their mental health, they want to have a happier future. I get a lot of job satisfaction in helping patients achieve this, and showing them there is help out there, life can be brighter, and is worth living.

Mental Health Practitioner is just one of the roles in the multi-disciplinary primary care team. For more information visit NHS England — North East and Yorkshire » Meet your General Practice Team