To ask whether you think we should have a bookable psychologist in every GP practice?

[DelBoyTrotter]

Would you want to book an appointment with a psychologist if you were suffering from mental health problems, or would you still want to see your GP?

A psychotherapist, yes.

Yes but who's going to pay for this service?

Just theoretical, Delete. But arguably it could be more financially efficient than all mental health problems going through GPs, etc.

Hm. I think I would rather see the GP at least initially but would be up for meeting psychologist after that. What kind of service would a psychologist provide though other than assessments? Talking therapies? Because surely you don't need to be a psychologist to competently provide a talking therapy anyway? Not sure there is much point, I would much rather have competent, qualified councellors (sorry can't spell) or CBT practitioners or psychotherapists etc at the GP surgery that you could self-refer to rather than a psychologist.

Surprisingly few mental health interventions are delivered by psychologists. I think a mental health nurse would be much better.

I agree with Four - a psychotherapist, or more like it, a team of psychotherapists, maybe with other mental health professionals. People could see the GP first if they wished to, and get referred to the practice psychotherapy / mental health team if appropriate. Mental health is so very badly neglected and not nearly enough long-term, intensive talking therapy support is available. 10 sessions of CBT may make a difference to some people but for many it wouldn't even begin to scratch the surface.

I dunno.

Would depend on what % of GP appts. involved MH, and whether it would be worthwhile employing a full-time member of staff.

Obviously most people would want to see a specialist over a GP- but that would apply to everything e.g. dermatology, gynaecology, neurology. It wouldn't be practicable to go straight to a consultant for most people.

I am a psychologist.... Yes!

Yes, yes, yes and absolutely YES!!!

God yes. I am seeing a therapist, and many friends are therapists/training to be because we all studied in a related field. The current system does not work - CBT (which has lower long-term efficacy) is prescribed left and right because it's cheap and easy to implement, and there are plenty of competent, highly-trained therapists out there without enough clients.

I think a cpn based in a GP practice would be an excellent idea. A GP appointment is often far too short to evaluate someone's mental health or whether medication is working. Sometimes talking therapies are inappriopiate. Its naivity to think that you can talk yourself out of a very serious illness.

However I think that strengthening GPs knowledge about pychiarity is important. A mother who is excessively anxious about her baby's health may well be suffering from severe anxiety or postnatal depression. I like the holistic approach of a good GP practice. In an ideal world you would see the same GP unless he/she had a day off was off sick.

Yes x 100. This would be so helpful.

I wondered whether a highly trained psychologist, who could do a thorough assessment and initiate psychological treatment in a variety of modalities would be best. Some psychotherapists are highly trained but only in one type of therapy, and not in broad psychological assessment skills.

I wondered whether this might reduce the extent to which people are quickly prescribed drugs (many of which are not nearly as effective as we're led to believe) because that's all that's quickly available.

If it was a well-trained psychologist, people could also go for kids' behavioural issues, developmental issues, etc. (as well as adult psychotherapy).

What type of psychologist are you, Plimsolls? Do you think this is the kind of job psychologists would be able to do well?

The mental health industry sometimes does its clients more harm than good. The rent a friend addictive types of theraphies are addictive and can reduce a person's confidence to problem solve. Many clients cannot cope with the issues of transference that long term therapy throws up. When the therapy comes to an end, the ending of that relationship can be difficult for the client.

CBT is bloody effective for a lot of people. It gives many people skills for life so that they are less likely to get sick again. Rather than depending on the therapist for social interaction they learn to make REAL friends and relationships. They learn to make real change in their lives so they get better and don't get sick again.

I feel a CPN would be good at monitoring the affects of medication and supporting people with a mixture of one to one and online CBT. An experienced CPN would have more time and know what is a normal reaction to life being awful and what is mental illness.

We better evidence based councelling and more control over therapist. The frightening thing is that anyone can set themselves up as a "therapist" and there is very little regulation. We also need to stop be niave and realise that talking therapies are not some kind of magic bullet.

delboy agree with all your points. I have professional doctorate in psychology (though my specialism is children & families so personally I'd not be an expert on adult psychiatric conditions eg). But yes, a highly trained doctoral psychologist who could perform the initial assessment and then either implement or recommend the correct treatment pathway (so at that point, refer to a CBt therapist if that most appropriate, or a psychoanalytic psychotherapist, or a person-centred counsellor etc etc) would be really effective. In my opinion, a doctoral psychologist would be best placed to do this accurately as they have more knowledge of psychological conditions, mitigating factors & whole range of interventions/approaches. (A doctoral psychologist is one who has min. 3 years of professional training and is usually a Clinical or Counselling or Child & Educational).

A good GP will know his or her patient. They may not have such specialist knowledge but they will already know the patient in many cases. Sometimes a personal relationship is more significant than knowledge of lots of fancy therapies.

I knew my GP from ante natal appointments, from taking by baby to the doctor. When I got ill it really helped me to have a friendly face that I knew. I would never had plucked up courage to see a complete stranger. I was so ill that councelling was never going to cut it. I felt scared and my GP persuaded me to take the medication I was so dead against.

Person centred councelling in my experience involved wallowing in self pity. The woe is me, I shall sit on my fanny approach made me more ill, emotionally dependent and encouraged learned helplessness. I think that learned helplessness is often a feature of people who spend years having counselling. Person centred councelling encourages people to ruminate over everything that is bad in life. That rumination can make the person feel worse without achieving anything.

A few years later I had anxiety and online CBT challenged me. Unlike person centred councelling there was not the bullshit of accepting everything I thought.

I think a mental health nurse/ CPN would be a really good idea. Nurses are generally easier to access than doctors so hopefully anyone struggling could get seen quickly. Maybe they could also handle some of the follow up and repeat prescription appointments too. Would a nurse be allowed to prescribe or adjust dosages for anti-depressants?

That interesting, Plimsoll.

I can see how a CPN would be really useful too for medication issues. But if we're trying to get away from medical approaches, wouldn't psychologists be better trained for this?

And what about for child behaviour/development issues? Personally, I'd love to be able to see an expert quickly and briefly to address these things rather than wait for (largely non-existent) CAMHS.

It's a nice idea, as is providing podiatrists, counsellors, physiotherapists, and probably lots of other people that patients would benefit from, but it would cost money that the NHS just doesn't have.

I was just looking at a news story about the proportion of people (including more and more kids) with mental health issues though, Oso, and the waits for/lack of provision, meaning people just get drugs. Is this on the same scale for other health issues?

I used to run a service for child behaviour/development issues and it was really popular. Did it through Sure Start & nurseries rather than GP surgeries. Generally was for "typical" developmental issues such as dealing with tantrums, sleeping, feeding, toileting. Had a specialist arm for children with complex needs, and there was an ongoing referral pathway for e.g. ASD assessments, if needed. Seemed to work really well and eased pressure on CAMHS too. I could see it being popular at GP surgeries.

I agree with plimsolls. What annoys me is how strategic managers seem to believe that highly trained professionals can be replaced by someone with a narrower qualification, at 60% of the cost - and get the same outcomes. Ludicrous!

I'm currently seeing a clinical psychologist every week for therapy. (I pay for it privately.) Previously I was seeing a counsellor (who isn't a psychologist). There is absolutely no comparison in the quality of therapy. While the counsellor was lovely, and I really liked talking to her, she lacked the training and expertise in general psychology and the workings of the brain that my current therapist has.

I have been making so much progress with the clinical psychologist. I still cry in almost every session (but then I do get emotional very quickly), but he has got me to a point where I am back at work 100% and I can sustain it. His advice is costing me the equivalent of a second mortgage per month but it's the best investment I've ever made.

Oh, and he works for the NHS in my area too, but I'd have to threaten to kill myself or other people and go through with it to be able to see him on the NHS. So yes, I am all for clinical psychologists being bookable on the NHS (though I doubt it will happen in the next 20 years).