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?

My GP has a CPN attached. Given the dire situation of psychiatric care, I think the first point should be picking up on those who are becoming, or already are, seriously mentally unwell. Too many people are being shunted out of secondary services when they still need intensive help. I know of cases where GPs have just about begged CMHT to take someone on, only to be told that they don't qualify, or they're not poorly enough, or they will have to wait six months to see someone. This can be a case of life and death.

It would be grrat to have longer-term psychological treatment available, but the most important thing to do right now is to stop lives being lost.

Many GPs that I've seen have a terribly limited knowledge of mental illness. (One looks petrified if I so much as mention my bipolar). A good CPN can be a hundred times more effective in helping to avert crises than a GP.

Good quality psychological support (not just CBT) could make a huge difference between someone trapped in their house, unable to work versus someone who can leave to 'live' their life. In the long run, it could be a cost effective investment in terms of people being able to work etc.

Well Really Tired person centred counselling might not have worked for you. It has been known to benefit other people and I suggest your description is simplistic and dismissive. Different approaches are helpful to different people.

Excellent idea. As long as they can offer CBT

"who's going to pay for it" .

If just be glad to have a bookable GP in mine.

I thibk the GP should be able to filter referrals still as they would just end up getting clogged up with time wasters and people with medical anxiety if it was a booking free for all wouldn't they?

I'd rather to see the GP to start with.

Also different therapists suit different people so there would need to be a way to be referred to one that was right for you, not just the "default" therapist at your own practice.

I would find this life changing if it existed.

YES

Definitely! Years ago I had anxiety and depression and was seeing a CPN. It did not help at all. Eventually I got a referral to a clinical psychologist who I saw for about 6 months and it was a tremendous help. To be honest - it changed my life.
Since then I have not needed any medication or further medical help.

A CPN attached is a good idea - I've always seen them as the gatekeepers sort of thing.

I was lucky(!) to have mental health problems whilst in the armed forces, as the help I got was very good and very quick.

With PND, just a few months of weekly sessions with a CPN combined with A-Ds was enough - I was off the A-Ds within 6 months.

I had anxiety and depression about 10 yrs later, again a few months with a CPN was all I needed to get back on track.

The latest episode I had was quite severe and over an extended period, I got worse & worse and the CPN referred me up to the Psychiatrist, who had a couple of meetings with me and moved me onto a consultant psychologist where I had CBT etc.
I ended up being diagnosed with bi-polar, and spent just over a year seeing the psychologist.

Few people actually need a psychologist, but a massive amount can benefit hugely from having quick access to a CPN.

In an ideal world, yes, definitely.

But I think there are many other more important things that need sorting out first.

*clinical psychologist, not consultant.

'person centred counselling might not have worked for you. It has been known to benefit other people and I suggest your description is simplistic and dismissive'

Completely agree. I have been in psychotherapy for 7 years and believe me, it has not involved any 'woe is me, I shall sit on my fanny'. It is work - flipping hard, gut wrenching work - and the most painful thing I have ever done, but also by far the best. I have changed hugely, for the better, and the absolute worst of my depression (self-loathing, urges to self-harm, alcohol abuse) has stopped. There is simply no way that I could have achieved a fraction of this in 10 CBT sessions or similar.

Awake, I do wonder about some 'counsellors'. My mother has started practicing as a 'bereavement counsellor' in the last few years. She's a raging narcissist who has no empathy, extremely poor listening skills and a desperate need for attention. I shudder to think what kind of 'support' she offers to people who are vulnerable and grieving.

I know that some counsellors are completely sound and no doubt highly effective, but I agree that there's a difference between a psychotherapist and a counsellor. Crying in sessions is good stuff by the way, even though it feels hideous. Good luck with it all - its seriously tough but seriously worth it x

But I think there are many other more important things that need sorting out first.

Like what? MH services in this country are appalling, many CMHTs are not fit for purpose, in my experience. I was recently discharged by my Psychiatrist as he 'needed to make a 25% saving'.
A trained MH professional in each surgery would be an excellent idea, in my opinion.

I wonder if it would actually cost that much? If you consider how much money is spent on the effects of untreated mental illness,.and how much is spent on drugs to "fix" various mental illnesses in the big scheme of things it might actually save money.

But that would require someone in the government capable of joined up thinking.

Lotta gosh, your mum's counselling sounds, er, interesting to say the least... My own counsellor was nothing like that thankfully. Very positive and supportive woman, but she just couldn't go deep enough and make the connections between all my different issues (depression and severe anxiety, both fuelled by fierce perfectionism and avoidance behaviour).

I have had CBT on the NHS too. I found it helpful, but the scope was far too narrow to make a lasting improvement.

For anyone who is considering psychotherapy, it is extremely hard work, whether it is CBT or a different approach or a mixture of approaches (as in my case). Well worth it, but gut wrenchingly hard.

I think it would be a brilliant idea.

From my experience of CMHT both as a user and an employee, the deluge of referrals could be cut if contact between a user and a MH professional occurred at first point. Many of the referrals were those from people who required more information that actual help - and were willing to help themselves, but the paperwork involved and the appointments that were necessary to do (usually over the phone, at inconvenient hours to those who were working) took up the majority of the time, adding to stress and unbearable work loads. In many cases, one phone call did most of the work.

I also agree with the poster who mentioned that GP's, due to time constraints, will often offer medication over therapy for two reasons a) treating the problem and b) knowledge of the waiting times for CMHT.

I also feel, especially for some, the experience of going to a MH professional rather than their GP may increase the likelihood of those who need help, actually seeking it - there is a lot of "Oh no, I don't have problems" when it comes to facing their own, sometimes family GP (although I'm loathe to admit, my experience suggests this is more a male feeling of pride) and may be more incline to see someone they wouldn't see routinely as part of any other medical intervention. Also, I noticed with a lot of male service users. they felt uneasy using up doctors time as they felt mental health wasn't a true illness and thus didn't want to bother them until absolutely desperate partners/families were intervening when the problem was far far more serious than it was initially.

I don't think that people with mental health issues should be entirely shunted away from GPs. Often people with pychiaratic issues have physiological problems that need addressing. It is a shameful fact that many people with serious mental health conditions have a much lower life expectancy than mentally healthy people. Often they die of things totally unrelated to their mental condition. There needs to be a more holistic approach to mental health that does not compartmentalise people. We are not robots and our physical and mental health are interlinked.

Maybe a CPN or a psychologist would prevent the gawd awful experiences I have had of councelling.

I don't think that people with mental health issues should be entirely shunted away from GPs.

That's true. People with minor and serious physical complaints still usually go to the GP as first port of call (or A&E) so it should be the same for mental illness. I'd be concerned that mental health was being made "second best" if people were sent to someone less qualified than a GP.

But I think there are many other more important things that need sorting out first.

Like what? MH services in this country are appalling, many CMHTs are not fit for purpose, in my experience. I was recently discharged by my Psychiatrist as he 'needed to make a 25% saving'. A trained MH professional in each surgery would be an excellent idea, in my opinion.

I know they are and I agree. But they aren't the priority, imo. Top on the list of more important things as far as I'm concerned would be any bookable doctors at all!

My experience of doctors over the last few weeks is having to call at 8.30am (while I'm supposed to be teaching!) for an appointment that day, having no choice in the time (if I even get one as they're all gone by 8.34) and then having to arrange for time off to go it at the very last minute.

My experience of mental health services is that the GP referred me on Thursday and I got a phone call on Friday to arrange an assessment, during which I had to talk them down from immediate action because I'd been referred as an emergency when I am not. Apparently GPs often refer as emergencies because physical health specialist can take months if you don't whereas mental health specialists are quicker.

Just one experience obviously but I've always found my mental health to be better dealt with than my physical health.

I'm a counselling psychologist and your gp can refer you onto my service.
Many surgeries have talking therapies available to them and often on site
there are good referals to services via the gp

i am unsure a psychologist is what you are looking for so therefore i think yabu

Also I often find that these threads offer information about talking therapies that can be really unhelpful
for very many people cbt helps a great deal
for very many people a more person centred approach is key.
for others a cpn is utterly fantastic

when therapy is discussed on mn very often someone's personal experience and their ability to commit to or engage in therapy at that time is used to dismiss or disparage a service that could be really helpful to another individual reading the thread

counsellor and psychotherapist is a term used interchangeably by many today practitioners today (although psychotherapists often have something to say about that)

bereavement counsellors are often (although not exclusively) befrienders and that is a mile away from being a trained therapist, counsellor or psychotherapist. The training to become any of the last three is extensive and involves many many hours of client work and academic work to degree or level 5. Post their training there is then an accreditation system that involves further work and and hours etc

i hope that this helps in some way and sorry to sound a bit of a warning bell but I have often seen such unhelpful commentary on here that I wanted to mention it before it takes a downturn

That's a really helpful post, Ronald.

Yes, thank you for that Ronald

Just one experience obviously but I've always found my mental health to be better dealt with than my physical health.

I have always experienced the opposite.